Are Productivity Goals in Rehabilitation Practice Associated With Unethical Behaviors?

OBJECTIVES: To evaluate the presence of productivity goals among licensed rehabilitation clinicians and their relationship with observed unethical behavior. DESIGN: Exploratory, cross-sectional survey. SETTING: Online. PARTICIPANTS: Licensed physical therapy clinicians (N=3446). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Participants completed an electronic survey regarding use of clinical productivity goals. They rated the frequency in which they observed 6 unethical behaviors on a 7-point Likert scale in their practice setting from 1=never to 7=always. An overall observed unethical behavior score was calculated by summing these scales. RESULTS: The response rate was 12.8% (N=3446), with analyses showing low risk of nonresponse bias. Many respondents (73.9%) had a formal productivity goal. Most (89.4%) reported observing some form of unethical behavior, but many (68.6%) reported it occurred "rarely" or "never." Those in skilled nursing facility (SNF) settings reported higher frequencies of observance and were 4.1 times more likely to report more unethical behavior than the median compared with all other settings. A positive correlation existed between expected productivity rate and rate of unethical behaviors observed (ρ=0.225; P<.0001). Amounts of organizational emphases on ethical practice (ρ=-0.509; P<.0001) and evidence-based practice (ρ=-0.492; P<.0001) were negatively correlated with total observed unethical behavior. CONCLUSIONS: Use of productivity goals in rehabilitation practice is significantly related with rate of unethical behavior observed. Frequency of observed unethical behavior in rehabilitation practice was very low overall. Organizational culture appears to be a greater predictor of observed unethical behavior than any individual clinician-related characteristics. The SNF setting displays the greatest areas of ethical concern.

Functional predictors of stair-climbing speed in older adults.

BACKGROUND AND PURPOSE: Falls on stairs are a common cause of injury and death among older adults. Although stair climbing is a component of some instruments that assess activities of daily living, normal speeds for safe stairway ambulation have not been established. Furthermore, little is known about which components of functional mobility are most highly associated with stair-climbing speed. The purposes of this study were to determine the range of normal stair-climbing speeds for ambulatory, community-dwelling older adults and identify which functional mobility tests could best explain this speed. METHODS: Twenty men and 34 women older than 65 years completed 6 functional mobility tests, including timed heel rises, timed chair stands, functional reach, one-legged stance time (OLST), a timed step test (alternately touching a step 10 times), and self-selected gait speed. Participants were then timed as they ascended and descended a flight of 8 to 10 steps. Combined ascent-descent times were used to calculate stair-climbing speed in steps per second. Stepwise regression techniques determined the best functional predictors for stair-climbing speed. RESULTS: Participants ascended and descended stairs at an average speed of 1.3 steps per second; men tended to ambulate stairs more quickly than women. The best predictors of stair-climbing speed were usual gait speed and OLST (R = 0.79; P = .01), which explained 63% of the variance in stair-climbing speed. DISCUSSION: Our results were similar to others who reported stair-climbing speeds ranging from 1.1 to 1.7 steps per second for older adults. However, the 2 predictors identified in this study provide a simpler and more accurate model for estimating stair-climbing speed than has been previously reported. Further research is needed to determine whether this speed is sufficient for negotiating stairs in an emergency. In addition, further study is needed to determine which tests/measures best differentiate individuals who can and cannot independently climb a typical flight of stairs. CONCLUSIONS: An older adult's stair-climbing speed can be accurately estimated by using a model that includes his or her usual gait speed and OLST. This information will help health care professionals and directors of residential facilities make appropriate decisions related to living accommodations for their older adult clients.

Evidence-supported rehabilitation of patellar tendinopathy.

Chronic tendinopathy is a common musculoskeletal disorder that frequently affects athletes who train and compete at all levels. This Clinical Commentary presents a review of the etiology, incidence, and contributory factors related specifically to patellar tendinopathy. Examination and differential diagnosis considerations are provided, and an evidence-based, staged rehabilitation program is described.

Grip strength of Texas Special Olympians.

Little is known about the physical fitness parameters of individuals who participate in the Special Olympics. The purpose of this study was to assess the grip strength of 104 Special Olympians participating in the winter Olympic Games. Men were significantly stronger than women across age groups 20 to 59 yr. Women's right hands were stronger than their left, while the opposite was true for men, despite the fact that 78.8% of the subjects reported right hand dominance. Mean right and left grip strengths were 25-40% less than the 1985 normative data of Mathiowetz, et al. by age groups. Special Olympian men and women have grip strengths comparable to elderly people rather than age-matched men and women.

Isometric strength and dynamic back extensor endurance are unrelated in children ages 6-10 years: a pilot study.

This study assessed the correlation between back extensor isometric force and dynamic endurance in 69 children 6-10 years of age. Subjects were positioned prone with legs and hips supported and restrained on two folded 6-in. mats. 42 subjects (20 girls; 22 boys) performed three 5-sec. isometric back extension efforts against a calibrated dynamometer and peak force values were averaged. An additional 27 subjects (9 girls; 18 boys) also performed a dynamic (0 degrees --> 45 degrees flexion-->0 degrees) back extension test at a frequency of 20 per minute, and the number of repetitions was recorded. Both tests were repeated at a 1-wk. interval. Pearson correlations for the endurance, the isometric force test, and test-retest, and between the functional concentric endurance vs isometric force were .55, .79 (both p<.01), and .03, respectively. These tests have moderate to high reliability but they examine different aspects of back muscle fitness. They should not be used interchangeably to assess back extensor muscle fitness. Further investigation must determine whether different dynamic test frequencies and mat heights yield different results.