Recurrence Quantification Analysis of Personal Statements from Applicants to a Physical Therapy Doctoral Program: A Cross-Sectional Analysis.

PURPOSE: We examined lexical sophistication of written personal statements from physical therapy applicants to determine whether recurrence quantification analysis (RQA) indices distinguish higher- versus lower-scored candidates and correlate with other admissions variables. METHODS: Written personal statements were extracted from 152 applications, coded numerically, and analyzed with RQA. Along with other RQA indices, determinism-representing predictability of words and phrases-was quantified. A receiver operating characteristic (ROC) curve analysis was used to examine discriminative validity of RQA indices to distinguish between top-10 and bottom-10 candidates. Correlation coefficients between RQA indices and other admissions variables (grade point averages, standardized exam, behavioral interview, and cumulative admissions scores) were also examined. RESULTS: Determinism in personal statements was lower in top-scored (mean 7.38%) than bottom-scored candidates (mean 11.29%, p = 0.015), differentiated between them with 70% sensitivity (95% CI 34.8%-93.3%) and 100% specificity (95% CI 69.2%-100%), and correlated negatively with candidates' behavioral interview scores (r = -0.168, p = 0.039). DISCUSSION: The greater expressive lexical sophistication characterized by lower determinism in personal statements provides information about candidates' writing proficiency as a component of their communication abilities that may not otherwise be assessed in traditional admissions variables.

Comparison of Cervical Range-of-Motion Restriction and Craniofacial Tissue-Interface Pressure With 2 Adjustable and 2 Standard Cervical Collars.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: The aim of the study was to compare and contrast the restrictiveness and tissue-interface pressure (TIP) characteristics of 2 standard and 2 adjustable cervical collars. SUMMARY OF BACKGROUND DATA: This study compared the restrictiveness and TIP of 4 commercially available cervical collars (2 standard and 2 adjustable). Adjustable collars offer potential advantages of individualized fit for patients and decreased inventory for institutions. The overall goal was to determine whether the adjustable collars provided the same benefits of cervical range-of-motion (CROM) restriction as the standard collars without increasing TIP and risk of pressure-related complications. METHODS: A total of 48 adult volunteer subjects (24 men and 24 women) were fitted with 4 collars (Aspen, Aspen Vista, Miami J, and Miami J Advanced) in random order. Data collection included assessment of CROM restrictiveness and measurement of TIP on the mandible and occiput in upright and supine positions. The experimental, repeated measures design stratified the sample by body mass index (BMI) and sex. RESULTS: All collars restricted CROM as compared with no collar (P ≤ 0.001 each). Aspen was more restrictive than Aspen Vista and Miami J in 4 movement planes (P ≤ 0.003 each), but not significantly different from Miami J Advanced. The Miami J standard collar was associated with significantly lower peak TIPs on all sites and in all positions compared with Aspen (P ≤ 0.001), Miami J Advanced (P < 0.001), and Aspen Vista (P = 0.01 for mandible site and upright position, P < 0.001 for remaining sites and positions). Increased peak TIP correlated with high BMI across all collar types, but was significantly lower for the Miami J collar than the Aspen collar. CONCLUSION: All collars, compared with no collar, significantly restricted CROM. Although the collar-to-collar comparisons were statistically significant, the differences may have little clinical significance in the acutely injured trauma patient. The Miami J standard collar had the lowest overall TIP in both sites and positions. Ongoing effort should be devoted to staff education in proper sizing and fit, particularly for patients with high BMI.

Use of individual feedback during human gross anatomy course for enhancing professional behaviors in doctor of physical therapy students.

Medical professionals and public consumers expect that new physical therapy graduates possess cognitive, technical, and behavioral skills required to provide safe and high-quality care to patients. The purpose of this study was to determine if a repertoire of ten professional behaviors assessed at the beginning of doctorate of physical therapy education and before the first significant clinical internship could be enhanced in a semester course in gross human anatomy using individual formative feedback. During the human anatomy course, 28 first-year physical therapy students completed six biweekly, anonymous self- and peer assessment surveys that targeted ten professional behaviors important to physical therapists. All professional behaviors were assessed using a five-point Likert scale. Feedback reports occurred at week eight (mid-semester) and week 16 (end-of-semester) and comprised the direct intervention components of this study. At the midpoint of the semester, professional behavior scores and narrative comments from weeks two, four, and six were compiled and shared with each student by one of three faculty members in a feedback session. Students then submitted biweekly self-and peer professional behavior assessments (weeks 10, 12, and 14) for the remainder of the human anatomy course. Differences between preintervention and postintervention scores for each of the ten professional behaviors were compared using the Wilcoxon signed-ranks test. Upon receiving mid-semester individual feedback, students demonstrated significant improvement in each of the ten professional behaviors. Results from this study indicated a gross anatomy laboratory dissection experience during the first academic semester provided an effective opportunity for teaching and assessing professional behaviors of doctoral students in physical therapy.

Collaborative model of clinical education in physical and occupational therapy at the Mayo Clinic.

Clinical education experiences, a significant portion of entry-level professional education programs in physical therapy (PT) and occupational therapy (OT), commonly use a one student to one clinical instructor (1:1) model. Recently, though, the collaborative model of clinical education has received more attention in the professional literature and in clinical education experiences. The collaborative model--where two or more students complete a clinical education experience within a specific clinical area while supervised and educated by one primary clinical instructor (2:1 or 3:1)--has been used historically within the Mayo Clinic's Department of Physical Medicine and Rehabilitation in PT and now OT. Clinical instructors, referred to as clinical education coordinators, supervise and educate students as a primary job responsibility. Students also teach and learn from each other. This article describes the collaborative clinical education model used at the Mayo Clinic. Benefits and challenges of the model, feedback from students who have participated in the model, and the productivity implications of using the model are included.

A grounded-theory investigation of patient education in physical therapy practice.

Patient education is a critical component of physical therapy and is used frequently in practice. Research describing the practice of patient education in physical therapy is scarce, however. Qualitative research methods can be used to describe the practice of patient education in physical therapy and to identify supportive theory. This study describes the practice of patient education grounded in data obtained from nine physical therapists in three settings: outpatient, acute care, and inpatient rehabilitation. From the data common themes are reported. From the themes, supportive theory can be identified. Results show four primary themes regarding patient education in physical therapy. First, the physical therapists in this study were not able to easily differentiate patient education from primary interventions. Second, the purpose of patient education was to empower patients toward self-management and prevention. Third, therapists used a patient-centered approach to decide upon content. Finally, each therapist used function or demonstration to assess the outcome of patient education interventions. The results of this study can be used to inform current practitioners, for future research and to identify theoretical underpinnings to support the practice of patient education in physical therapy.

Retrospective analysis of the behavioral interview and other preadmission variables to predict licensure examination outcomes in physical therapy.

Evidence supporting the use of personal interviews in admissions decisions for health professions programs is conflicting. This retrospective study was intended to (1) quantify interrater reliability for assessing performance on a particular type of structured interview, the behavioral interview, and (2) examine the ability of multiple preadmission variables, including performance on the behavioral interview, to predict first-time performance on the national physical therapy licensing examination (NPTE). Data from 89 interviewees during the 2006-07 admissions cycle were used to examine inter-rater reliability. Data from 141 students who graduated from 2001 to 2005 were used to examine predictive validity of multiple preadmission variables on NPTE performance, including undergraduate cumulative grade point average (GPA), preprofessional science GPA, performance on the Graduate Record Examination (GRE) (including its analytical, quantitative, and verbal subscales), and performance on the behavioral interview. Inter-rater reliability for assessing interview performance was quantified with an intraclass correlation coefficient (ICC1,1). Receiver operating characteristic (ROC) curves and associated validity indices were used to analyze variables that distinguished graduates who did and did not pass the NPTE on their first attempt (alpha = 0.05). The ICC1,1 for assessing interview performance was 0.749. Performance on the verbal subscale of the GRE (ROC curve area = 0.734, p = 0.007) and behavioral interview (ROC curve area = 0.685, p = 0.034) were statistically significant predictors of NPTE performance. This study provides evidence supporting the contributions of the behavioral interview and verbal subscale of the GRE to predict NPTE performance and assist admissions decisions.

Range-of-motion restriction and craniofacial tissue-interface pressure from four cervical collars.

BACKGROUND: Occipital pressure ulcers are well-known complications for trauma patients wearing cervical collars. We assessed the effects of four commercial cervical collars (Aspen, Philadelphia, Miami J, and Miami J with Occian back [Miami J/Occian]) on cervical range of motion (CROM) and mandibular and occipital tissue-interface pressure (TIP). METHODS: Forty-eight healthy volunteers (24 men, 24 women; mean age, 38.9 years +/- 10.5 years) were stratified by body mass index. CROM was measured in the seated position without and with collars. Sagittal, coronal, and rotatory CROM was measured with a goniometer. Occipital and mandibular pressures were mapped with subjects in upright and supine positions. RESULTS: All collars significantly restricted CROM in all planes (p < 0.001). The Philadelphia and standard Miami J collars were the most restrictive. The Aspen collar was the least restrictive for flexion and rotation. The Miami J/Occian back was the least restrictive for extension and lateral flexion. For supine measurements, Miami J and Miami J/Occian back had the lowest mean TIP, whereas Aspen and Philadelphia collars had the greatest (p < 0.001). For upright measurements, the Miami J/Occian back produced the smallest mean TIPs; the other collars, ranked by ascending TIP, were Philadelphia, Miami J, and Aspen (p < 0.001). Philadelphia and Miami J collars had significant collar-body mass index interaction effects on supine occiput mean pressure (p = 0.04). CONCLUSIONS: Miami J and Philadelphia collars restricted CROM to the greatest extent. Miami J and Miami J/Occian back had the lowest levels of mandibular and occipital pressure; these collars may markedly reduce the risk of occipital pressure ulcers without compromising immobilization.

The thoracic suspension orthosis--a seating option for patients with pressure ulcers.

BACKGROUND/OBJECTIVE: For patients with pressure ulcers, wound healing and prevention are important steps in reducing disability. Ulcers that fail to heal adequately may interfere with normal sitting. By relieving pressure, the thoracic suspension orthosis (TSO) may allow some patients with recurrent pressure ulcers to return to sitting and sit for longer periods. METHODS: In this retrospective case series, 6 patients with chronic pressure ulcers were managed with TSO. Each patient had at least one of the following: (1) severe, non-healing pressure ulcers unresponsive to standard therapy, (2) recurrent ulcers requiring multiple surgeries, (3) chronic pain associated with sitting, or (4) bilateral lower extremity amputation resulting in instability or ischial pain in the seated position. RESULTS: Each participant had a favorable functional outcome. Patients were able to resume modified sitting. Others were able to sit for longer periods. Some have used the TSO for long-term management. CONCLUSIONS: A TSO is an additional seating option for patients with chronic pressure ulcer, chronic pain associated with sitting, or bilateral lower extremity amputation. It is recommended after less restrictive, conservative measures have failed. In some patients, it has been used in lieu of extreme surgical measures.