A Continuous Quality Improvement Framework for Sustainable Action and Advancement of Diversity, Equity, Inclusion, and Belonging in Physical Therapy.

BACKGROUND AND PURPOSE: To address racial and ethnic disparities, physical therapy organizations, educational institutions, and clinical practices seek to advance diversity, equity, inclusion (DEI), and social justice in health care. Although our professional organizations have crafted proclamations, resource lists, developed new accreditation standards, and strategic plans, we lack a unifying framework and action tools for substantial and sustained progress. In addition, the DEI acronym is missing the essential element of belonging (B), that is, sharing a sense of purpose and feeling safe to contribute opinions as a valued member of an organization. Therefore, the purpose of this position paper is to propose the utilization of a continuous quality-improvement (CQI) framework using Plan-Do-Study-Act (PDSA) cycles to advance DEI-B in physical therapy education and practice. POSITION AND RATIONALE: The CQI framework and PDSA cycles are data-driven, iterative approaches for identifying areas for improvement, implementing interventions, collecting data, analyzing outcomes, and taking evidence-based next action steps. Application of this framework can enhance sustainability of DEI-B goals and foster progress toward the proposed accreditation criteria of the Commission on Accreditation in Physical Therapy Education in this critical area. Tenants for PDSA team success are presented, and PDSA cycles are described. DISCUSSION AND CONCLUSION: Addressing racism and advancing DEI-B efforts in the physical therapy profession requires bold, sustained, and intentional action that incorporates standards, strategies, and methods for measuring change. Examples of PDSA DEI-B initiatives, interventions, and outcomes are provided to illustrate how this approach can be implemented within a physical therapy education program. Using this CQI framework provides our profession with a DEI-B roadmap for advancing incremental and sustained progress.

Usability and Efficacy of Neurologic Digital Case Studies to Promote Clinical Decision-Making Skills Among Physical Therapist Students.

Clinical decision-making (CDM) is essential to professional competency but remains a difficult concept to teach and learn. The purpose of this study was to assess usability and efficacy of digital case studies for development of CDM skills within the neurologic physical therapy curriculum. METHOD: A two-part pilot study was designed to: 1) examine the usability and perceived efficacy of digital case studies; and 2) examine the efficacy of case studies upon student CDM skill development. Twenty-one students participated in the initial pilot study and were given a 5-question survey and open-response questions that were analyzed quantitatively and qualitatively. The second phase of the study consisted of two groups (n=48): one completed digital case studies, and another completed paper cases. Both groups completed pre- and post-tests, and data were analyzed using independent sample t-test for comparing mean difference. ASSESSMENT: Students reported digital case studies as user-friendly, but there was no statistically significant difference found in CDM between groups. CONCLUSION: While the use of digital case studies generated student satisfaction, they do not appear to eclipse low-tech options in terms of efficacy. Various pedagogies can yield similar results, and thus faculty resources should be considered when developing educational methodologies.

Facilitators and barriers to enrolling in falls prevention programming among community dwelling older adults.

The purpose of this cross-sectional survey study was to identify factors that increase the likelihood of enrolling in falls prevention programming among community dwelling older adults. A convenience sample of 369 participants completed a written, selfadministered questionnaire on history and beliefs related to falls, and facilitators and barriers associated with enrollment. History of falling, fear of falling, self-efficacy, and recognition of program benefits were all associated with a greatly likelihood to enroll in falls prevention programming. Additionally, seven facilitators were associated with greater likelihood to enroll, including offered close to home (OR = 6.75(3.829-11.898); p = 0.000), free vision screen (OR = 4.816 (1.442-16.084); p = 0.005), friendly leader (OR = 3.930 (2.049-7.538); p = 0.000), coffee hour to socialize (OR = 3.789 (1.309-10.971); p = 0.009), no cost (OR = 3.653 (2.125-6.253); p = 0.000), group exercise (OR = 2.584 (1.341-4.980); p = 0.004), and safe place (OR = 2.378 (1.181-4.789); p = 0.013). Physician advice to attend a program, however, was not associated with likelihood to register (p = 0.99), supporting the need for a paradigm shift from physicians serving as the key change-agent in falls prevention to multiple partnerships. In addition, although 72% of participants were likely to register for a falls prevention program, only 28% knew if a program was being offered in their community. These findings highlight a critical need to disseminate information about falls prevention programming through social marketing in locations where older adults go in their everyday lives.

Support Needs and Coping Strategies as Predictors of Stress Level among Mothers of Children with Autism Spectrum Disorder.

This study examined maternal stress, coping strategies, and support needs among mothers of children with Autism Spectrum Disorder (ASD). A convenience sample of 70 mothers completed the Parent Stress Index Short Form (PSI-SF), Coping Health Inventory for Parents (CHIP), and Modified Family Needs Questionnaire (FNQ). PSI-SF scores reflected clinically significant levels of stress for 77% of mothers, and mothers identified 62.4% of important needs as unmet. The five most frequently reported important unmet needs were (1) financial support; (2) break from responsibilities; (3) understanding of other after-school program children; (4) rest/sleep; (5) help remaining hopeful about the future. Most coping strategies (81%) were identified as helpful. Additionally, both coping strategies and support needs served as predictors for maternal stress. Maternal stress scores decreased by .402 points for each percent increase in helpful coping strategy, and stress scores increased by .529 points with each percent increase in unmet needs. Given large variation in questionnaire responses across participants and studies, utilization of user-friendly questionnaires, such as the PSI-SF, CHIP, and FNQ, is advocated to determine the evolving important needs unique to each family over the child's lifetime as well as guide prioritization of care, compilation of resources, and referrals for additional services.