Virtual Rehabilitation and COVID-19: Varied Adoption and Satisfaction Among Patients and Providers Participating in a Multi-Site Survey Study.

The COVID-19 pandemic compelled rapid healthcare adaptations including increased use of telehealth (TH) and virtual care (VC) to provide rehabilitation services. This multi-site cross-sectional survey study examined rehabilitation patients' and providers' experiences with service delivery during the COVID-19 pandemic, including the use of TH/VC. Patients and providers who received or provided rehabilitation services were recruited from 1 of 3 large, post-acute rehabilitation systems located in the Southeastern and Midwestern United States during the COVID-19 pandemic. Participants rated personal satisfaction with rehabilitation services received or rendered during the pandemic and willingness to use TH/VC in the future. Questions also addressed accessibility, ease of use, and perceived barriers to TH/VC use. The adoption and personal satisfaction of TH/VC for rehabilitation care varied between patients and providers. Patients reported higher levels of satisfaction compared to providers (P < .001). Patients who did not use TH/VC had higher satisfaction than those who did (P < .05). Patients were less willing than providers to use TH/VC (P < .001). Those who used TH/VC prior to the pandemic were more willing to use post-pandemic (P < .001). Patients reported TH/VC was useful in increasing health services accessibility yet were neutral as to the ability of TH/VC to improve outcomes. Patients and providers agreed that TH/VC was easy to learn and use. Medical providers found TH/VC more useful than therapy providers. Participants who used TH/VC during the pandemic are more willing to use the service again in the future. Understanding patient and provider preferences and perspectives is key to the continued use of TH/VC in rehabilitation care.

Structural Equation Modeling: Effects of Master Adaptive Learner and Clinical Learning Environment Attributes on Career Satisfaction and Intention to Stay.

OBJECTIVE: The objective of this observational study was to test a proposed conceptual model depicting the influence of personal and environmental attributes of clinical learning environments on rehabilitation professionals' career satisfaction and intention to stay with their current organization. The mediating effects of 2 loci of engagement were also assessed. METHODS: Rehabilitation professionals (physical therapists, occupational therapists, speech-language pathologists, and registered nurses; n = 436) from 4 health care organizations in the Northeast, Southeast, and Midwest regions in the USA completed a battery of questionnaires related to personal attributes (resilience and orientation toward lifelong learning), environmental attributes (innovation support and basic psychological need satisfaction at work), loci of engagement (professional and organizational), career satisfaction, and intention to stay. Data were analyzed using structural equation modeling. RESULTS: The measurement and structural model fit was acceptable. The greatest total effects on career satisfaction (r = .459) and intention to stay (r = .462) were observed through the influences of basic psychological need satisfaction, professional engagement, and organizational engagement. Orientation toward lifelong learning was negatively associated with career satisfaction (r = -.208) and intention to stay (r = -.154), but this was mitigated by organizational engagement (r = -.060 and - .134, respectively). Small but significant total effects were also observed between innovation support, professional and organizational engagement, and intention to stay (r = .144) and resilience, professional and organizational engagement, and career satisfaction (r = .110). CONCLUSION: Clinical learning environments that support rehabilitation professionals' basic psychological needs (autonomy, competency, and relatedness) are associated with greater career satisfaction and intention to stay. This association is further enhanced by organizational engagement and innovation support. IMPACT: Rehabilitation organizations interested in developing and retaining master adaptive learners should create clinical learning environments that reinforce rehabilitation professionals' sense of autonomy, competency, and relatedness, and are supportive on innovative behaviors.

Identifying Perspectives on Physical Therapist Residency Program Goals: Hallmarks of Success and Excellence.

OBJECTIVE: The purpose of this study was to describe common perspectives important to achieving excellence and success in physical therapist residency education programs. METHODS: Individuals with direct responsibility for creating and revising physical therapist residency program goals participated in a mixed-methods study using Q-methodology. They sorted 31 goal topics based on the level of importance for achieving excellence and success in physical therapist residency education. By-participant factor analysis identified dominant perspectives, which were interpreted based on emergent themes from the topics identified as the most important. Participants' rationale for selecting goal topics as the most important were extracted from the post-survey. RESULTS: Seventy-three individuals responded, representing 9 of the 11 clinical residency areas of practice. Three main perspectives emerged: resident behaviors, resident achievements, and program attributes. One shared perspective emerged across all 3 factors that emphasized the residents' ability to become self-regulated, lifelong learners who integrate learning into practice: preparation for future learning. CONCLUSIONS: Variability in weighting the importance of program goals associated with each perspective may include a program's organization and mission, individual beliefs and experiences related to program leadership, and resource availability. Although respondent emphasis placed importance of some items over others, the findings do not suggest that items ranked lower were unnecessary or unimportant in achieving program excellence. The relative importance of items was weighted differently based on the perspective of program leadership and the individual completing the sorting activity. IMPACT: The results of this study suggest that physical therapist residency programs should have at least 1 or 2 goals in each of the 3 distinct perspectives, as well as the 1 shared perspective identified in our findings. Some consistency in program goals based on the perspectives identified here may enable further research exploring excellence, value, and outcomes in physical therapist residency education.

What Determinants Affect Inpatient Satisfaction in a Post-Acute Care Rehabilitation Hospital?

OBJECTIVE: To examine how specific hospital service domains (personal issues domain, discharge domain, rehabilitation doctor domain, nursing domain, physical therapist domain, occupational therapist domain, and food domain) influence final patient satisfaction scores, the overall quality of care, and willingness to recommend the hospital to others among patients in an inpatient rehabilitation hospital. DESIGN: Longitudinal study. SETTING: Patient-level data from electronic medical records were joined with Press Ganey (www.pressganey.com) satisfaction data for a single post-acute care inpatient rehabilitation facility in northeast Florida. PARTICIPANTS: Patients who participated in the inpatient rehabilitation survey (N=4,785). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Main outcome measures included final patient satisfaction scores, overall rating of care during the stay, and willingness to recommend the hospital to others. RESULTS: This study found the personal issues domain to be the most important factor in determining the final patient satisfaction score, overall rating of care, and likelihood to recommend the hospital to others, followed by the physical therapist, nurse, discharge, and food domains (P<.0001). Within the personal issues domain score, staff promptness and explanation upon arrival were areas identified as opportunities to make improvements that would result in the greatest positive effect. CONCLUSIONS: This work represents novel findings by investigating the major determinants of positive patient experience in a rehabilitation hospital setting. These findings provide actionable information to improve patient experience as well as where to focus improvement efforts using limited resources.

Student Physical Therapists' Orientation to Postprofessional Education and Perceptions of Strain: Identification of 4 Subgroups of Students Based on Cluster Analysis.

INTRODUCTION: Determining why physical therapists choose certain pathways to expertise is not well understood. Developing an understanding of these different choices is important for the physical therapy profession and the future of postprofessional education. REVIEW OF LITERATURE: Pathways to expertise as a physical therapist have evolved over the history of the profession, including the most recent emergence of residency education. Regardless of the path taken, physical therapists have a societal duty to be lifelong learners. The decision on which path to pursue is influenced by many factors, including financial stress, personal factors, and relational obligations. Developing an understanding of these different pathways and barriers for physical therapists is essential if the physical therapy profession is to advance with the evolving needs of society. SUBJECTS: Participants were from a stratified purposive sample of Doctor of Physical Therapy Students (n = 124) across the eastern, central, and western regions of the United States. METHODS: This study was a secondary analysis using hierarchical cluster analysis based on students' orientation toward lifelong learning and future professional engagement, self-rated likelihood of pursuing various postprofessional education pathways, and perception of personal and interpersonal strains as a barrier to postprofessional education. RESULTS: The cluster analysis resulted in a 4-cluster solution representing different student subtypes: clinically oriented average learners; resilient, clinically oriented lifelong learners; academically oriented lifelong learners; and strain-limited, clinically oriented lifelong learners. DISCUSSION AND CONCLUSION: Results from this study describe important differences in how student physical therapists view postprofessional education and the pathways they choose to pursue. Factors such as lack of awareness and the perception of personal or interpersonal strain may influence these decisions. Understanding postprofessional education decision making of student physical therapists is of particular interest to the physical therapy profession given the current debates related to student debt and the necessity of residency education. Further research is needed to understand how to increase awareness and diminish barriers to quality postprofessional education for physical therapists.

Essential Components of Physical Therapist Management of Patients With Osteoporosis: A Delphi Study.

BACKGROUND AND PURPOSE: Osteoporosis is a systemic, metabolic bone disease that affects bone quality, increases susceptibility to low-trauma bone fracture, and has downstream effects on falls and fragility fractures. Osteoporosis is a multifactorial disease process that requires management from multiple health care providers including physicians, nurses, and physical therapists. However, the paucity of information regarding comprehensive physical therapist management for patients with osteoporosis indicated the need for an evidence-based document. The purpose of this document was to provide the best available expert guidance for clinicians in the selection of screening tools, essential tests and measures, treatment goals, and interventions for patients with osteoporosis. METHODS: A Delphi process was used. Thirty-one physical therapists with expertise in the care of patients with osteoporosis participated in a series of 3 sequential surveys designed to build and reach agreement on the management of patients with osteoporosis. The desired survey outcomes were to: (1) identify the range of examination and plan of care components considered important to physical therapists' care for patients with osteoporosis, (2) determine which components should be considered essential, and (3) achieve consensus on the final list of essential components and related operational definitions. RESULTS: A clear consensus on the essential components of examination and interventions was achieved. In general, there were 4 to 6 items across each category of history, tests and measures, education/goals, and treatment. CONCLUSIONS: The prioritization of these management items will better support clinicians working with adults who have osteoporosis.

American Physical Therapy Association Clinical Practice Guideline Implementation for Neck and Low Back Pain in Outpatient Physical Therapy: A Nonrandomized, Cross-sectional Stepped-Wedge Pilot Study.

OBJECTIVE: To determine whether a multifaceted implementation strategy for American Physical Therapy Association neck and low back pain clinical practice guidelines (CPGs) was associated with changes in clinician and patient outcomes. DESIGN: Cross-sectional stepped-wedge pilot study. METHODS: Physical therapy clinics (n = 9) were allocated to 1 of 4 clusters that varied by CPG implementation timing. Clinics crossed over from usual care (control) to CPG implementation (intervention) every 8 weeks and ended with a 24-week follow-up period. Implementation outcomes were measured at the clinician (perspectives and behaviors) and patient (pain and disability outcomes) levels. Descriptive statistics were used to summarize clinician perspectives and behaviors. Generalized linear mixed models were used to analyze patient-level outcomes data (pain and disability) and total number of physical therapy visits. RESULTS: Improvements in several clinician perspectives about CPGs were observed 8 weeks after training and sustained at 16 weeks (P<.05), although it is unclear whether these changes were meaningful. Training on CPGs was relevant to physical therapists and more acceptable at 16 weeks (P<.05). In a random sample (n = 764/1994, 38.3%), the overall rate of CPG classification was 65.0% (n = 497/764), and CPG intervention concordance was 71.2% (n = 354/497). Implementation of a CPG was not associated with final pain and disability scores (P>.05) but was associated with an approximate increase of 8% in total visits. CONCLUSION: Our multifaceted implementation strategy was associated with statistical changes in clinician perspectives and behaviors, but not in patient outcomes. J Orthop Sports Phys Ther 2022;52(2):113-123. doi:10.2519/jospt.2022.10545.

Covid-19 Impacts on Florida's Healthcare Professionals.

This study described how COVID-19 impacted employment, telehealth usage, and interprofessional collaboration. A cross-sectional survey was deployed in June 2020 to healthcare professionals in Florida. Job status was uniquely separated by profession, with more nurses and medical doctors reported having no effect, and more mental health counselors transitioned to telehealth. Over a third of rehabilitation providers reported being furloughed. Over forty percent of providers had no training in telehealth, yet 33.1% reported an increase in usage. Interprofessional interactions are lower across professions during the pandemic, compared with before. This study shows the need for additional training on telehealth and interprofessional collaboration.

Evaluation of a Head-Tongue Controller for Power Wheelchair Driving by People With Quadriplegia.

The head-tongue controller (HTC) is a multimodal alternative controller designed for people with quadriplegia to access complex control capabilities by combining tongue and head tracking to offer both discrete and proportional controls in a single controller. In this human study, 17 patients with quadriplegia and current users of alternative controllers were asked to perform four trials of either simple driving tasks or advanced maneuvers in a custom-designed course. Completion time and accuracy were compared between their personal alternative controller (PAC) and various combinations of driving modalities with the HTC. Out of 8 subjects assigned to simple driving, the best HTC trial of 3 subjects was completed faster than their PAC for the tasks of rolling forward and turning around cones, and 5 subjects in rolling backward. Across all these subjects, the average completion time of their best HTC modality is 23 s for rolling forward, 15 s for rolling backward, and 70 s for turning around cones as compared to 19 s, 17 s, and 45 s with their PAC. For advanced driving, the course was completed faster with the HTC by 1 out of 9 subjects, while the best HTC trials of all subjects are less than 1.3 times of their best PAC completion time with an average of 170 s for the HTC and 140 s for their PAC. The qualitative feedback provided by all subjects to a post-study questionnaire scored to an average of 7.5 out of 10 which shows their interests in the HTC and acknowledgement of its usefulness for this population.

Musculoskeletal pain stakeholder engagement and partnership development: determining patient-centered research priorities.

BACKGROUND: Musculoskeletal (MSK) pain is a global public health problem with increased societal burden. Increased attention has focused toward patient and other stakeholder perspectives when determining future MSK pain research priorities, however infrastructure and capacity building within the community are needed for individuals and organizations to participate in patient-centered outcomes research. The purpose of this manuscript is to describe our collaborative experiences with several MSK pain stakeholders and processes to identify a top priority research topic. METHODS: Lunch meetings and formalized workshops were used to develop infrastructure for engaging patients and other stakeholders with early capacity building for partners to identify MSK pain research ideas based on their personal experiences. Additional capacity building and engagement through literature searching further prepared partners to contribute informed decisions about MSK pain research topics and subsequent selection of an important research question. RESULTS: Several key deliverables (e.g., Governance Document, Communication Plan) were developed and completed over the course of this project to provide partnership structure. Other key deliverables included a list of preliminary comparative effectiveness research ideas (n = 8) and selection of shared decision making for MSK pain as the top priority research topic with patient partners identifying pain self-efficacy as an important outcome domain. CONCLUSIONS: Our patient partners provided the catalyst for identifying shared decision making as a high priority research topic based on a wide spectrum of stakeholder perspectives and unique experiences. Patient partners were primarily identified using a single rehabilitation health system and clinician partners were heavily weighted by physical therapists which may have introduced selection bias.

Laser testing for upper extremity proprioceptive deficits following rotator cuff injury: two case reports.

Background: Rotator cuff (RTC) dysfunction incidence ranges from 7% to 25% in the general population with a high recurrence rate. RTC musculature plays a significant role in dynamic stability of the glenohumeral joint with damage to these structures associated with proprioceptive impairments. Impaired proprioception has been linked to increased injury risk in other body regions; however, similar relationships with the upper extremity have not been extensively evaluated. The purpose of this case report is to present a preliminary, yet clinically feasible approach for using a laser for proprioceptive assessment and treatment in patients with RTC dysfunction. Case description: Patient 1 was a 21-year-old female with right shoulder pain from injury at work as a waitress where she lifted a heavy tray of plates. Patient 2 was a 48-year-old male with gradual and insidious onset of right shoulder pain during recreational baseball. Examination findings indicated contractile tissue involvement in both patients. Reaching and throwing tasks requiring accurate proprioceptive function were essential for return of each patient to their functional tasks. Laser proprioception testing was performed every 2 weeks with proprioceptive training provided as a supplement to other interventions. Outcomes: Over 4 weeks, improvements in objective laser proprioceptive test results were observed for both patients (Patient 1 = 6.0 cm; Patient 2 = 5.5 cm) in conjunction with active range-of-motion and self-report measures for pain intensity and function. Discussion: This case report describes a clinically feasible approach to testing and treating upper extremity proprioceptive deficits after RTC injury. Future research is required to establish reliability and validity of these methods.

Motivations to Pursue Physical Therapy Residency Training: A Q-Methodology Study of Stakeholder Perspectives.

BACKGROUND: Residency training is recognized as a valuable form of professional development and pathway to specialization. Currently residency is voluntary for physical therapists, with less than 12% of DPT students choosing to apply upon graduation. Motivations that drive the decision to pursue residency are currently unknown as is the extent of similarity and difference in perspective among various stakeholders. OBJECTIVE: The purpose of this study was to identify the dominant perspectives on motivations to pursue residency held by various stakeholders. DESIGN: This study was conducted using Q Methodology, which incorporates aspects of quantitative and qualitative techniques into the examination of human subjectivity. METHODS: Program directors, faculty, and current residents from all accredited physical therapy residency programs were invited to complete a forced-choice sorting activity where potential motivations for residency were sorted by perceived level of importance. Principal component analysis was used to identify dominant perspectives, which were interpreted based on emergent themes in the cluster of motivations identified as most important. RESULTS: Four dominant perspectives were identified: (1) desire to provide better patient care, (2) preparation for specialty practice, (3) fast track to expert practice, and (4) career advancement. These perspectives provided context and utility to 2 broad meta-motivations: improved clinical reasoning and receiving mentoring. Both within- and between-group differences among stakeholders were identified. However, subsets from each role-group population were found to share similar perspectives. LIMITATIONS: Results from this study may not apply to potential residents in all specialty areas, and the implications of having a particular perspective are unknown. CONCLUSIONS: Identification of the dominant perspective on motivations for pursuing residency may aid in promoting participation, program development, matching residents to programs and mentors, and future research.

Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report.

STUDY DESIGN: Case report. BACKGROUND: Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. CASE DESCRIPTION: The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. OUTCOMES: Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). DISCUSSION: This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.

Recognition and management of BPPV for an elderly female patient referred for low back pain: a resident's case study.

Benign paroxysmal positional vertigo (BPPV) is common among older adults and frequently misdiagnosed or unidentified. Undiagnosed BPPV has been associated with depression, falls and ADL limitations. This case study describes the diagnostic process and management of BPPV for a 65-year-old patient with a primary complaint of chronic low back pain (LBP) in an outpatient orthopedic physical therapy setting. Following routine screening performed on initial evaluation, the patient was educated about examination findings that indicated the potential for BPPV and given the option to proceed with further assessment or defer until LBP was under control. The patient attended 16 visits over the course of care and the complaint of vertigo, described as a true spinning sensation, was assessed further on the visit 5. Continued assessment confirmed BPPV and the canalith repositioning procedure was administered. Following positive response to this intervention, the maneuver was re-administered on visit 6. Complete resolution of symptoms was reported on visit 7 and for the remainder of physical therapy services over the following month. Physical therapists may play a vital role in reducing healthcare expenses associated with cost to arrive at the diagnosis of BPPV, as well as improving the quality of life and safety of the older adult population affected by BPPV.