Guideline adherent screening and referral: do third year Doctor of Physical Therapy students identify red and yellow flags within descriptive patient cases? a United States based survey study.

INTRODUCTION: The need for early detection and appropriate management of flags in physical therapy has been established. The lack of early detection has been shown to lead to poor outcomes such as serious pathology, increased disability, prolonged symptoms, and increased healthcare utilization. OBJECTIVE: The main purpose of this survey study was to assess third-year Doctor of Physical Therapy (DPT) students' adherence to clinical practice guidelines specifically in the identification and management of red and yellow flags through a case-based approach. METHODS: A survey including three different flag case scenarios was sent to DPT students in 15 geographically diverse physical therapy programs. Previously published case scenarios measuring adherence to practice guidelines were used. Correlational analyses were performed to link student demographic details and guideline adherent management. RESULTS: The survey was completed by 64 students. Guideline adherent management was greater for red flags (85%) than yellow flag cases (25% and 42%). No significant relationship was noted between the student details and guideline adherent management. CONCLUSION: DPT students may need additional educational content related to yellow flag screening. Educators may consider utilizing published red and yellow flag cases to guide decision-making and highlight best screening practices.

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.

The Role of Patient Recovery Expectations in the Outcomes of Physical Therapist Intervention: A Systematic Review.

OBJECTIVE: The purpose of this study was to determine the association between baseline patient recovery expectations and outcomes following physical therapy care. METHODS: PubMed, CINAHL Complete, PEDro, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO were searched from inception to February 2021. Concepts represented in the search included physical therapy, patient expectations, patient outcomes, and their relevant synonyms. Two reviewers independently screened studies of article abstracts and full texts. Eligibility criteria included English language studies that evaluated adults seeking physical therapist intervention for any health condition where both patient outcome (recovery) expectations and functional or other outcome measures were reported. Methodologic standards were assessed using the Critical Appraisal Skills Program criteria. Data were extracted using a custom template for this review with planned descriptive reporting of results. Vote counting was used to measure reported outcomes. RESULTS: Twenty-one studies were included in this review, representing 4879 individuals. Studies were most commonly prospective cohort studies or secondary analyses of controlled trials. Varied expectation, outcome, and statistical measures that generally link patient recovery expectations with self-reported outcomes in musculoskeletal practice were used. CONCLUSION: Patient recovery expectations are commonly associated with patient outcomes in musculoskeletal physical therapy. IMPACT: Evidence supports measuring baseline patient expectations as part of a holistic examination process.

Update on distance and velocity requirements for community ambulation.

PURPOSE: The purposes of this study were to provide an update to the ambulatory distance requirements for community ambulation and to update gait speed performance and requirements at intersections. METHODS: Distances were measured at 9 types of sites using a rolling measuring device in accordance with the protocol set forth by Lerner-Frankiel and associates. The 9 types of sites were supermarkets, drug stores, banks, department stores, post offices, medical offices, superstores, club warehouses, and hardware stores. Gait speed allotted by crosswalk signals as well as the gait speeds of individuals through crosswalks were recorded. Qualitative observations of the pedestrians' age (older - 65 years; younger < 65 years) and sex were also noted. RESULTS: Distances were measured at 141 different establishments. The shortest mean distance requirement was found in the medical offices at 65.82 (32.28) m. Club warehouses had the longest mean distance requirement at 676.82 (159.36) m. The mean gait speed used by the pedestrians (N = 139) was 1.32 (0.31) m/s while the mean speed necessary as set by the crosswalk signals was 0.49 (0.20) m/s. All of the individuals observed were able to cross the street within the allotted time and with adequate speed. The gait speeds met the normative data established for age and sex as well as data reported for slower older adults and some with incomplete spinal cord injury. CONCLUSIONS: Distance requirements for full community ambulation may need to be increased to 600 m or more. Gait speed requirements at crosswalks in the communities measured are set to accommodate the gait speed capabilities of older pedestrians who attempt crossing at controlled intersections.