The Relationship Between Professionalism and Leadership: Parent-Child or Sibling?

Professionalism has been the foundation of physical therapy's contract with society, with the American Physical Therapy Association's (APTA) Core Values and Code of Ethics serving as its building blocks. Professional formation has focused on professionalism and has been taught in a manner that is more implicit than explicit in doctor of physical therapy (DPT) curricula. As a domain of competence, professionalism alone has not been broad enough to meet societal needs. In reaching our centennial year, many have reflected on what competencies are needed to move forward. The need for leadership competencies is not new and has been espoused by our leaders over the past 100 years. Some advocate for the adoption of leadership as a unique domain of competence, separate from the domain of professionalism, whereas others propose that either professionalism or leadership is one domain of competence that subsumes the other. The purpose of this Perspective is twofold: to compare and contrast the concepts of professionalism and leadership, and to make recommendations regarding what constitutes domains of competence within the professional formation of physical therapists. This Perspective offers recommendations addressing professional formation and the adoption of leadership and professionalism as 2 distinct domains of competence and discusses educational and clinical implications of the recommendations. This Perspective asserts that these recommendations must be adopted to move the profession forward into the next century so that physical therapists are recognized as adding value to the health care system and the evolving needs of society.

Self-Leadership Is Critical for All Physical Therapists.

Evidence that supports the explicit need to develop leadership skills at all levels of clinical practice is prevalent,1-8 yet intentional development of "self-leadership" within health care, and particularly within physical therapy, remains slow, fragmented, and inconsistent. Delineation and standardization of the definition of leadership, and the approach to developing leadership skills in individuals practicing within health care continues to be debated, producing several key dilemmas. Moreover, there is a lingering misperception that developing leadership capacity is reserved for physical therapists who assume positional or formal roles as "leaders" within communities, health care organizations, practices, or teams. This misperception focuses leadership development on "leading others" rather than "leading self." Similarly, challenges exist between balancing the leadership development needs of the leader as a positional role and the act of "leading" as physical therapists practice and engage within all levels of care and within different communities-as individuals and within teams. This tension further complicates when and how best to prepare physical therapists to meet this essential skill set in clinical practice. The purpose of this perspective is to describe nonpositional self-leadership and its importance to physical therapy practice, to propose common or contemporary leadership-related terminology, and to suggest a framework for leadership development. Through accomplishing these purposes, readers may be encouraged to change and adopt recommendations.

Exploring the Concept of Leadership from the Perspective of Physical Therapists in the United States.

Purpose: The purpose of this study was to examine the perceptions of physical therapists practising in the United States of the importance of leadership characteristics and of demographic traits and other factors that might be associated with perceptions of leadership in three contexts: workplace, health care system, and society. Method: An online questionnaire was distributed through snowball sampling to physical therapists practising in the United States over an 8-week period between October and November 2019. A total of 15 leadership characteristics were rated on a 5-point scale of importance. Results: A total of 278 physical therapists responded to the questionnaire. They rated communication and professionalism as the top two leadership characteristics across all settings. Self-awareness and business acumen were not perceived as important for leadership. No relationship was found between gender and self-declaration as a leader or between a participant's practice setting and their rating of the importance of leadership characteristics. Conclusions: Our results further the discussion of leadership in the physical therapy profession. They highlight a comprehensive acceptance of leadership characteristics as important regardless of context. Further work will be necessary to transition this declaration of the importance of leadership skills to identifying the essential leadership skills for physical therapist education and clinical practice.

Objectif : examiner les perceptions des physiothérapeutes des États-Unis à l'égard de l'importance des caractéristiques de leadership, des caractéristiques démographiques et d'autres facteurs susceptibles d'être associés aux perceptions de leadership dans trois contextes : le milieu de travail, le système de santé et la société. Méthodologie : distribution en ligne d'un questionnaire par échantillonnage en boule de neige aux physiothérapeutes qui exercent aux États-Unis, sur une période de huit semaines entre octobre et novembre 2019. Au total, les chercheurs ont évalué 15 caractéristiques de leadership sur une échelle de cinq points. Résultats : au total, 278 physiothérapeutes ont répondu au questionnaire. Ils ont classé la communication et le professionnalisme au sommet des caractéristiques du leadership dans tous les contextes. Ils n'ont pas perçu la conscience de soi ni le sens des affaires comme des éléments importants du leadership. Ils n'ont constaté aucun lien entre le genre et l'autodéclaration de leader ou entre le milieu de pratique d'un participant et son classement de l'importance des caractéristiques de leadership. Conclusion : les résultats font évoluer les échanges sur le leadership dans la profession de la physiothérapie. Ils font ressortir l'acceptation complète de l'importance des caractéristiques du leadership, quel que soit le contexte. D'autres travaux s'imposent pour faire transiter cette déclaration sur l'importance des capacités de leadership vers la détermination des compétences de leadership essentielles pour l'enseignement de la physiothérapie et la pratique clinique.

Increased lumbar spinal column laxity due to low-angle, low-load cyclic flexion may predispose to acute injury.

Lumbar spinal column laxity contributes to instability, increasing the risk of low back injury and pain. Until the laxity increase due to the cyclic loads of daily living can be quantified, the associated injury risk cannot be predicted clinically. This work cyclically loaded 5-vertebra lumbar motion segments (7 skeletally-mature cervine specimens, 5 osteoporotic human cadaver specimens) for 20 000 cycles of low-load low-angle (15°) flexion. The normalized neutral zone lengths and slopes of the load-displacement hysteresis loops showed a similar increase in spinal column laxity across species. The intervertebral kinematics also changes with cyclic loading. Differences in the location and magnitude of surface strain on the vertebral bodies (0.34% ± 0.11% in the cervine specimens, and 3.13% ± 1.69% in the human cadaver specimens) are consistent with expected fracture modes in these populations. Together, these results provide biomechanical evidence of spinal column damage during high-cycle low-load low-angle loading.

Ring apophysis fractures induced by low-load low-angle repetitive flexion in an ex-vivo cervine model.

Ring apophysis fractures of the spine occur in physically-active adolescents causing low back pain and the potential for chronic pain. Many of these fractures occur without memorable trauma, suggesting that the fractures occur during everyday movements and activities. The benign nature of this poorly understood potential mechanism of injury hampers appropriate diagnosis and early treatment. The purpose of this study was to establish an ex-vivo model of ring apophysis fracture and demonstrate that these fractures can be initiated by repetitive non-traumatic loading. Six 5-vertebra cervine lumbar (L1-L5) motion segments were cyclically loaded in low-angle low-load flexion (to 15° flexion, with peak load of 230±50N), a representative movement component of daily activities for both human and deer lumbar spines. Pinned end conditions replicated physiologically realistic loading. Ring apophysis fractures were created under low-load low-angle conditions in healthy vertebrae of similar bone mineral density and a similar degree of skeletal maturity to adolescent humans. All specimens developed ring apophysis fractures, some as early as 1400 cycles. The load-displacement data, and hysteresis loops during the cyclic loading, suggest that the fractures occurred gradually, i.e., without trauma. The ease at which these fractures were created suggests that ring apophysis fractures may be more prevalent than current diagnosis rates. Therefore, clinically, healthcare providers should include the potential for ring apophysis fracture in the differential diagnosis of all physically-active adolescents who present with back pain.