Physical therapy students' application of an imaging decision rule for acute knee pain.

BACKGROUND: Evidence supports direct referral for imaging by physical therapists. Accuracy and self-efficacy for imaging decisions have not been investigated in entry-level doctor of physical therapy (DPT) students. OBJECTIVE: The purpose of this study was to understand the relationship between entry-level DPT instruction and accuracy and self-efficacy for imaging referral due to acute knee trauma. A second purpose was to identify relationships between accuracy and self-efficacy. METHODS: An online survey was sent via e-mail to program directors in accredited DPT programs in the United States with an invitation to forward the survey to DPT students. The survey captured demographic information and included five questions that assessed the respondent's ability to apply the Ottawa Knee Rules (OKR). Self-efficacy was assessed using the Physiotherapist Student Self-Efficacy (PSE) questionnaire, a self-rated 5-point Likert scaled tool. RESULTS: Of 240 surveys, DPT students who completed imaging coursework had greater accuracy and higher self-efficacy (68.0% correct (95% CI, 63.6-72.5), PSE = 3.67, P < .001) compared to students who had not (45.8% correct (95% CI, 40.8-50.7), PSE = 2.67, P < .001). Conclusion: Accuracy by DPT students who completed imaging coursework was significantly improved and comparable to values from autonomous providers.

Doctor of Physical Therapy Education in a Hybrid Learning Environment: A Case Report.

OBJECTIVE: The purpose of this case report is to describe the implementation and report early outcomes of a 2-year (6-trimester), hybrid doctor of physical therapy (DPT) program. METHODS: The case report describes management of (1) academic affairs, (2) student affairs, (3) faculty affairs, and (4) institutional affairs for an accredited, fully hybrid, 2-year DPT program. In the hybrid program, students from across the country participate in synchronous and asynchronous online learning and travel to campus twice per trimester for immersive blocks of in-person laboratory instruction. The case report describes how the program structures the hybrid learning environment and reports outcomes from the first 2 graduated cohorts. RESULTS: Program outcomes assessment revealed that 97% to 98% of students/graduates reported being somewhat or very satisfied with the 2-year hybrid DPT program at the end of DPT year 1, at graduation, and at 1 year after graduation. Clinical instructors reported that 84% of students were prepared or well-prepared for clinical education. At 1 year after graduation, 20% of graduates were enrolled in or had completed residency, National Physical Therapy Examination (NPTE) pass rate was 97%, and employment rate was 99%. CONCLUSION: Hybrid DPT education is feasible and may provide opportunities for more flexible and accessible delivery of DPT education. Outcomes of this case report suggest high student satisfaction, increased student/graduate diversity, and graduate outcomes comparable with national averages as reported in the Commission on Accreditation in Physical Therapy Education aggregate data. IMPACT: This case report provides early evidence that hybrid DPT education-a type of blended learning that uses both face-to-face and online instructional strategies-is feasible, with student satisfaction and student/graduate outcomes comparable with national averages. Hybrid education may provide educators, programs, and institutions the flexibility to innovate in ways that address some of the immediate and long-term challenges facing physical therapist professional education while maintaining standards of excellence.

The How and the Why of Including Children: Experiential Learning in Teaching Physical Therapist Students.

PURPOSE: This study describes experiential learning (EL) activities with children and the rationale for using EL. Experiential learning with children in entry-level doctor of physical therapy (DPT) education has not been described. METHODS: Eighteen pediatric educators from accredited DPT programs participated in semistructured, in-depth interviews. Researchers analyzed written interview transcriptions using an iterative, consensus-building, thematic analysis approach. RESULTS: Educators described their EL activities. Educators' rationale for using EL grouped around 4 themes: (1) EL is valued by multiple stakeholders, (2) EL provides an additional learning modality, (3) EL introduces students to pediatric physical therapy, and (4) EL addresses standards and competencies for DPT education. CONCLUSIONS: This research provides a rich description of EL with children and rationale for integrating EL in DPT education. These findings may inform educators and program directors regarding the value of EL and the investment of resources to support EL in DPT education. SUPPLEMENTAL VIDEO ABSTRACT AVAILABLE: at: http://links.lww.com/PPT/A386.

Experiential Learning in Pediatric Physical Therapist Education: Challenges and Facilitators.

PURPOSE: The purpose of this study was to conduct an in-depth investigation of physical therapist educators' challenges to and facilitators of the use of experiential learning (EL) with children. Although EL with children has been called an essential component of doctor of physical therapy (DPT) education, variability in the amount of EL used among DPT programs indicates that educators may experience different challenges and facilitators of the use of EL. METHODS: Eighteen pediatric DPT educators participated in a semistructured interview. Researchers used thematic analysis to qualitatively analyze interview transcripts. RESULTS: Three themes emerged: (1) stakeholder considerations, (2) pedagogical considerations, and (3) logistical considerations. CONCLUSIONS: This research illustrates challenges and facilitators to the use of EL with children. How these challenges and facilitators are perceived by DPT educators has implications for faculty and program directors, particularly as they consider the use of EL with children in DPT programs nationally.

Experiential Learning in Pediatric Physical Therapist Education: Faculty and Student Perceptions.

SUBJECTS: Faculty teaching pediatric content in accredited doctor of physical therapy programs was recruited; 106 responded. Students representing 20 participating programs were also invited to participate; 23 responded. METHODS: Participants received an online questionnaire including closed- and open-ended questions regarding EL with children. Descriptive statistics were used to describe responses. Responses to open-ended questions were compiled and reviewed. RESULTS: Respondents reported an average of 12.4 hours of EL with children in required courses. Satisfaction with quality was stronger than with amount of EL. Several perceived barriers and facilitators were reported. CONCLUSIONS: Use of and satisfaction with EL with children in physical therapists' education vary. Continued research on this variation and potential effects to educational outcomes is needed.

Doctor of Physical Therapy Education in a Hybrid Learning Environment: Reimagining the Possibilities and Navigating a "New Normal".

Professional physical therapist education has experienced a transformation over the last few decades, moving to a doctoring profession with more autonomy and a broader scope of practice. These changes have occurred in parallel with systemic and structural changes in health care and higher education, both of which have experienced challenges with improving access and controlling costs, and have become a centerpiece of legislative and political discourse. At the same time, advances in technology have introduced new possibilities in education, with the emergence of online, blended, and "flipped" learning models that supplement or replace face-to-face instruction with distance learning. Hybrid education is a type of blended learning, utilizing both face-to-face and online instructional strategies. In a hybrid learning environment, online content may be delivered synchronously or asynchronously, replacing traditional face-to-face instructional time and reducing "seat time" for students. Recent attention has been brought to online and hybrid/blended learning in physical therapist education in the wake of the COVID-19 pandemic, as programs have been required to abruptly move from face-to-face to remote instruction. Hybrid and other forms of blended learning strategies have been described at the physical therapist education course level. However, there is no literature describing hybrid learning implementation at the physical therapist education program "levels," and there has been limited discussion on best practices for delivering hybrid, blended, and online instruction in physical therapist education. This perspective provides an overview of hybrid education, describes theoretical frameworks that guide implementation of a hybrid education curriculum, and discusses future directions for hybrid physical therapist education and educational research.

Development of a Grading Rubric to Assess Learning in Pediatric Physical Therapy Education.

The purpose of this perspective article is to describe the development and potential use of a grading rubric to assess pediatric psychomotor and clinical reasoning skills in professional pediatric physical therapist students. Feedback from focus groups made up of pediatric physical therapy educators informed development of the rubric. In addition, preliminary reliability and feasibility of the rubric were evaluated using videotaped student performance on a related pediatric case. Pilot data suggest a range of reliability between slight and moderate across the components of the rubric. Both the case and the rubric are included as appendices, and recommendations are provided for implementation and for future research.

Exploration of Content and Reach of Physical Therapy-Related Discussion on Twitter.

BACKGROUND: Many individuals access and share health information on social networking sites. Previous studies have analyzed the social media site Twitter to discern public opinion related to health phenomena such as antibiotics, concussions, and flu. Physical therapy-related online discussions have not been studied. OBJECTIVE: The aim of this study was to explore content, participants, and structure of physical therapy-related discussions on Twitter. DESIGN: This study was observational. METHODS: Over 12 weeks, more than 30,000 physical therapy-related tweets were collected. A random sample of 100 tweets underwent preliminary analysis to determine broad categories including tweet author, tone, and theme. A second random sample of 100 tweets was analyzed to confirm categories. Once categories were established, a new sample of 1000 tweets was randomly selected for analysis and categorization. All study investigators categorized a shared collection of tweets to establish inter- and intrarater agreement. Twitter conversations were visualized using NodeXL. RESULTS: Intrarater and interrater agreement for tweet categorization was 95% and 89%, respectively. The distribution of the intended audience was 35.5% professional, 35.5% broad reach, and 29% public. The gross distribution of tweet tone was 63.1% neutral, 31.4% positive, and 5.6% negative. Twenty-eight percent of tweets were authored by physical therapists/physical therapist assistants and nearly one-half were categorized as "marketing." Tweets tended to be "isolated," not within a conversation, or consist of conversation within "tight crowds." LIMITATIONS: This study was purely observational. Social media content can be highly influenced by temporal events, which limits the generalization of specific findings. CONCLUSIONS: Study results indicate that the reach of physical therapy-related tweets may not be as broad as intended by the author. Physical therapy professionals and the hospitals/clinics that employ them may need to implement strategies to be more intentional in reaching a broader audience with online messages.

Predictive Validity of the Premie-Neuro at 3 Months' Adjusted Age and 2 Years' Chronological Age.

BACKGROUND: It is difficult to predict which preterm babies are most at risk for poor neurodevelopmental outcomes. A quick, highly predictive assessment tool would aid neonatal clinicians in making decisions about follow-up care. PURPOSE: The purpose of this study was to determine whether performance on the Premie-Neuro in the neonatal intensive care unit predicted neurodevelopmental outcomes at 3 months' adjusted age and 24 months' chronological age. METHODS: Thirty-four preterm infants were administered the Premie-Neuro in the neonatal intensive care unit. Infants were assessed using the Infanib and Alberta Infant Motor Scales at 3 months' adjusted age, and using the Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III) at 24 months' chronological age. Scores were analyzed to determine whether Premie-Neuro performance at less than 37 weeks postmenstrual age was predictive of neurodevelopmental outcomes at 3 months' adjusted age and 24 months' chronological age. RESULTS: Premie-Neuro raw scores were predictive of outcomes at 3 months' adjusted age and 24 months' chronological age. Premie-Neuro classifications were not predictive of Infanib and Alberta Infant Motor Scale classifications at 3 months' adjusted age but were predictive of Bayley-III classification at 24 months' chronological age. IMPLICATIONS FOR PRACTICE: Premie-Neuro raw scores may be used by the clinician to identify infants at risk for neurodevelopmental delays. Premie-Neuro classifications should be interpreted cautiously. IMPLICATIONS FOR RESEARCH: More research is needed to determine whether the Premie-Neuro may be used as an adjunct to clinical assessment to identify infants who are most at risk for developmental delay.

Using twitter in health professional education: a case study.

PURPOSE: The vast majority of health care students, providers, and organizations utilize social media to access and share information. However, there is little research exploring integration of social media into health professional education. This case study describes how the social media site Twitter was used in a first-year physical therapy professionalism course to teach, support, and model professional online communication. METHODS: Twitter was used for discussion and sharing among 36 doctor of physical therapy (DPT) students enrolled in a first-year professionalism course. Participants completed four Twitter assignments. Outcome measures included student surveys of overall social media use, perceptions of Twitter use in the course, Twitter use during the course, and student engagement measured using a subset of questions from the National Survey of Student Engagement (NSSE). OUTCOMES: During the course, students posted a total of 337 tweets (mean 9.36 tweets/student). Pre- and post-course surveys showed an increase in academic and professional social media use. Perception of Twitter use in the course was generally positive. There was a small increase in mean NSSE score that was not statistically significant. DISCUSSION: Using Twitter in a physical therapy professionalism course was a positive experience for students and was associated with increased academic and professional social media use. Future studies are needed to determine whether deliberate teaching of social media as a professional technology competency will result in meaningful increases in professional online engagement and improved digital professionalism in health professional students and providers.

Professionalism in a digital age: opportunities and considerations for using social media in health care.

Since the beginning of the millennium, there has been a remarkable change in how people access and share information. Much of this information is user-generated content found on social media sites. As digital technologies and social media continue to expand, health care providers must adapt their professional communication to meet the expectations and needs of consumers. This adaptation may include communication on social media sites. However, many health care providers express concerns that professional social media use, particularly interactions with patients, is ethically problematic. Social media engagement does not create ethical dissonance if best practices are observed and online communication adheres to terms of service, professional standards, and organizational policy. A well-executed social media presence provides health care providers, including physical therapists, the opportunity-and perhaps a professional obligation-to use social media sites to share or create credible health care information, filling a consumer void for high-quality online information on fitness, wellness, and rehabilitation. This perspective article provides a broad review of the emergence of social media in society and health care, explores policy implications of organizational adoption of health care social media, and proposes individual opportunities and guidelines for social media use by the physical therapy professional.

The premie-neuro: opportunities and challenges for standardized neurologic assessment of the preterm infant.

PURPOSE: To determine the interrater and test-retest reliabilities and construct validity of the Premie-Neuro, a standardized neurologic assessment tool for preterm infants. SUBJECTS: Thirty-four preterm infants (mean gestational age at birth 29 ± 3.7 weeks, mean birth weight 1343.2 ± 696.3 g) participated in the study. DESIGN: A prospective repeated-measures design was used to assess the reliability and validity of the Premie-Neuro. METHODS: The Premie-Neuro was administered twice on consecutive days and then weekly through 37-weeks postmenstrual age or hospital discharge. At discharge, infants' medical histories were reviewed and a Neurobiologic Risk Score (NBRS) was used to determine risk for poor neurodevelopmental outcomes. MAIN OUTCOME MEASURE: Premie-Neuro raw scores and classifications were analyzed to determine the tool's reliability. Construct validity was measured by determining whether the Premie-Neuro could discriminate between infants identified as high-risk or low-risk for neurodevelopmental delays by using a NBRS of 5 as the cutoff for high- and low-risk infants. RESULTS: The intraclass correlation coefficients for interrater and test-retest reliability varied from 0.391 to 0.556 and from 0.493 to 0.592, respectively. Analysis of variance revealed that the Premie-Neuro raw scores for infants with NBRS > 5 were significantly worse than those for infants with NBRS < 5 (P = .000-.010). CONCLUSIONS: The Premie-Neuro is a valid assessment tool for discriminating between preterm infants at high and low risk for neurodevelopmental delay. Interrater reliability of the Premie-Neuro was poor, and test-retest reliability of the Premie-Neuro was fair to moderate. The Premie-Neuro may be acceptable for assessing groups of infants, but there is no evidence that reliability is sufficient for clinical decision-making for individual infants. More research needs to be done to improve the reliability of the Premie-Neuro and assess other facets of the Premie-Neuro's reliability.