Physical Therapy in a General Hospital: A Guide for the Chief Physical Therapist: Organizational Responsibilities

1953 ◽  
Vol 33 (4) ◽  
pp. 161-165
Author(s):  
Margaret L. Moore
Keyword(s):  
Physical Therapy ◽  
General Hospital ◽  
Physical Therapist

scholarly journals Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

2013 ◽  
Vol 93 (7) ◽  
pp. 975-985 ◽  
Author(s):  
Heidi J. Engel ◽  
Shintaro Tatebe ◽  
Philip B. Alonzo ◽  
Rebecca L. Mustille ◽  
Monica J. Rivera
Keyword(s):  
Quality Improvement ◽  
Physical Therapy ◽  
San Francisco ◽  
Physical Therapist ◽  
Medical Center ◽  
Early Mobilization ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Icu Admission ◽  
Number Of Patients

Background Long-term weakness and disability are common after an intensive care unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventative early mobilization. Objective The study objective was to describe a quality improvement project established by a physical therapist at the University of California San Francisco Medical Center from 2009 to 2011. The goal of the program was to reduce patients' ICU length of stay by increasing the number of patients in the ICU receiving physical therapy and decreasing the time from ICU admission to physical therapy initiation. Design This study was a 9-month retrospective analysis of a quality improvement project. Methods An interprofessional ICU Early Mobilization Group established and promoted guidelines for mobilizing patients in the ICU. A physical therapist was dedicated to a 16-bed medical-surgical ICU to provide physical therapy to selected patients within 48 hours of ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients receiving physical therapy under usual care practice in the same ICU in 2009. Results From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. The median times (interquartile ranges) from ICU admission to physical therapy evaluation were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length of stay decreased by 2 days, on average, and the percentage of ambulatory patients discharged to home increased from 55% to 77%. Limitations This study relied upon the retrospective analysis of data from 6 collectors, and the intervention lacked physical therapy coverage for 7 days per week. Conclusions The improvements in outcomes demonstrated the value and feasibility of a physical therapist–led early mobilization program.

scholarly journals Breathing: A Sign of Life and a Unique Area for Reflection and Action

2008 ◽  
Vol 88 (7) ◽  
pp. 832-840 ◽  
Author(s):  
Kirsten Ekerholt ◽  
Astrid Bergland
Keyword(s):  
Physical Therapy ◽  
Physical Therapist ◽  
Well Being ◽  
Qualitative Approach ◽  
Breathing Patterns ◽  
Daily Lives ◽  
The World ◽  
Body And Soul ◽  
Bodily Sensations ◽  
Conscious Attention

Background and Purpose The aim of this study was to clarify patients’ experiences of breathing during therapeutic processes in Norwegian psychomotor physical therapy (NPMP). Subjects and Methods A qualitative approach was used based on interviews with 9 women and 1 man aged between 41 and 65 years. The data were analyzed with the aid of grounded theory. Results Three categories were identified from the participants’ experiences: (1) “Breathing: An Incomprehensible and Disparate Phenomenon,” (2) “Breathing: Access to Meaning and Understanding,” and (3) “Breathing: Enhancing Feelings of Mastery.” Initially, breathing difficulties and bodily pains were described as physical reactions that seemed utterly incomprehensible to the participants. Communication, both verbal and nonverbal, between the patient and the physical therapist was described as vitally important, as was conscious attention to occurrences during the treatment sessions. The participants learned to recognize changes in their breathing patterns, and they became familiar with new bodily sensations. Consequently, they acquired new understanding of these sensations. The feeling and understanding of being an entity (ie, “body and soul”) emerged during therapy. The participants increased their understanding of the interaction between breathing and internal and external influences on their well-being. Their feelings of mastery over their daily lives were enhanced. The therapeutic dialogues gave them the chance to explore, reflect, and become empowered. Discussion and Conclusion In experiencing their own breathing, the participants were able to access and identify the muscular and emotional patterns that, linked to particular thoughts and beliefs, had become their characteristic styles of relating to themselves and the world.

A Knowledge Translation Framework for Optimizing Physical Therapy in Patients With Heart Failure

2021 ◽  
Author(s):  
Konrad J Dias ◽  
Michael J Shoemaker ◽  
Kristin M Lefebvre ◽  
John D Heick
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Physical Therapy ◽  
Knowledge Translation ◽  
Cardiorespiratory Fitness ◽  
Practice Guideline ◽  
Physical Therapist ◽  
Evidence Based ◽  
Patients With Heart Failure ◽  
The Continuum

Abstract The American Physical Therapy Association (APTA) has supported the development of clinical practice guidelines to promote and support evidence-based practice and reduce unwarranted practice variation. Essential to the success of this effort is the generation of knowledge translation—a concept that emphasizes the translation of global knowledge to an application that can be effectively integrated into clinical practice. The Physical Therapy Clinical Practice Guideline for the Management of Individuals with Heart Failure published in the Physical Therapy Journal in January 2020 provides a broad base of knowledge related to evidence-based treatment interventions for patients with heart failure. However, the application and integration of this knowledge in clinical practice need further elucidation. Therefore, this perspective paper aims to serve as a complementary knowledge translation resource to the recently published practice guideline to maximize the utilization of contemporary evidence in clinical practice. This resource provides the physical therapist with practical guidance in the management of patients with heart failure by placing research findings in the context of other knowledge and practice norms that can be applied at the point of care and across the continuum of care. We propose a novel ABCDE (Assessment, Behavior, Cardiorespiratory Fitness, Dosage, and Education) practical framework. This clinical paradigm is grounded in ongoing physical therapist assessment throughout the episode of care, along with behavior modification, assessment of cardiorespiratory fitness, appropriate selection and dosing of interventions and patient education. Examples highlighting the use of this model in patients with heart failure across the continuum of care are provided for application in clinical care.

scholarly journals Effect of Physical Therapy on Fall-Risk and Physical Status in Older Adults with Frailty and Metabolic Syndrome

2020 ◽  
Vol 5 (6) ◽  
pp. 282-291
Author(s):  
N. P. Koval ◽  
◽  
M. G. Aravitska
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Metabolic Syndrome ◽  
Physical Therapy ◽  
Therapeutic Alliance ◽  
Fall Risk ◽  
Physical Therapist ◽  
Main Group ◽  
Frailty Syndrome ◽  
Physical Status

The constant increase in the proportion of the disabled or partially disabled elderly population and, accordingly, patients of this age contingent, leads to the need for rehabilitation and physical therapy of persons with geriatric syndromes and various comorbid pathologies. The purpose of the study was to determine the effectiveness of a physical therapy program based on the dynamics of indicators of the fall-risk and physical status in older adults with frailty syndrome and metabolic syndrome. Material and methods. 96 older adults were examined. The control group consisted of persons without metabolic syndrome and without frailty syndrome. The main group 1 consisted of persons with metabolic syndrome and frailty syndrome who did not express a desire to cooperate with a physical therapist and / or actively improve their health on their own (low level of therapeutic alliance). They were provided with recommendations on the WHO CINDI program (diet modification, extension of household and training physical activity). Main group 2 included patients who showed consent to take active steps to improve their own health under the supervision of a physical therapist (high level of therapeutic alliance). We developed a physical therapy program for them using kinesitherapy, massage, nutritional correction, education of the patient and his family, elements of cognitive training and occupational therapy for one year. The dynamics of the state was assessed according to the results of the Short Physical Performance Battery, hand dynamometry, Senior Fitness Test, the Berg Balance Scale. Results and discussion. Older adults with metabolic syndrome and frailty syndrome demonstrated a high fall-risk (according to the results of a Short battery of physical activity tests and the Berg scale) and a statistically significant lag in physical status parameters (coordination, balance, strength, flexibility, endurance, agility) according to the parameters of the Senior Fitness Test, hand dynamometry, Short battery of physical activity tests) from their peers. These results increase the risk of adverse health effects, loss of autonomy and death. The use of physical therapy in main group 1 subjects led to a statistically significant (р<0.05) improvement in physical qualities, a decrease in the intensity of frailty signs; leveling the fall-risk in them. The low level of therapeutic alliance of persons in the main group 2 led to unsatisfactory fulfillment or non-fulfillment of the recommendations provided and is associated with a lack of improvement in their physical status and a high fall-risk. Conclusion. It is advisable to include physical therapy means in the rehabilitation programs for elderly patients with comorbid pathology of frailty and metabolic syndrome

scholarly journals EARLY PHYSICAL THERAPY INTERVENTION CAN REDUCE THE CHANCE OF RESPIRATORY COMPLICATIONS IN COVID-19

2020 ◽  
Vol 4 (1) ◽  
pp. 137-138
Author(s):  
Syed Alamadar Hussein ◽  
◽  
Raheela Kanwal ◽  
Huma Balqias ◽  
Usman Farooq ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Pulmonary Function ◽  
Physical Therapist ◽  
World Health ◽  
Respiratory Complications ◽  
Positive Effects ◽  
Breathing Exercises ◽  
Lung Expansion ◽  
Postural Drainage ◽  
Initial Symptoms

Since the start of 2020, a COVID-19 emerged as a new strain of Coronavirus. Initially, it affected the population of Wuhan, China and after that it outspread all over the world and was declared as a pandemic by World Health Organization on 30th January, 2020.1 It has been identified that COVID-19 can cause mild illness including common cold to more severe condition known as acute respiratory distress syndrome (ARDS), if not treated promptly.2 While people of all ages are susceptible to COVID-19, those over 60 years of age and with cardiovascular diseases along with diabetes have even more chances of becoming seriously ill Whereas children seem to be less affected.3 Currently there is no pharmacological treatment, still some antiviral drugs have been proven to be helpful along with plasma transfusion in which plasma is extracted from the blood of patient who got recovered from COVID-19 an is transfused into the patient still suffering from the said disease.4 Symptoms of respiratory complications due to this disease influence the mind of a Physical Therapist (PT). Though after discussing the maneuvers of respiratory Physical Therapy with fellow professional colleagues as well as clinicians and practically applying it on respective relatives, friends and advice seekers after getting the informed consent from them; those who started to have initial symptoms of COVID-19 before being tested positive and then later got positive. It resulted in great ease for most of them to breathe and did not led to serious respiratory complications that include dyspnea and accumulation of thick and tenacious secretions inside the lungs, which ultimately is a precursor of pneumonia. Following were the PT interventions suggested to the patients showing acute symptoms; Steam inhalation, breathing exercises and postural drainage positions were inculcated in the treatment plan and guided respectively, steam inhalation therapy is normally advised to be used as primary care in acute respiratory diseases.5 It is most commonly used therapy at home and is inexpensive, moreover it promotes self-reliance in the patients; it is used therapeutically by inhaling steam through nose so that it reaches the respiratory system.6-8 Steam inhalation helps in loosening the mucus, it opens the nasal airway passages decreases mucosal inflammation and heat can prevent replication of viruses.9 It helps to relax muscles and relieves coughing by preventing excessive dryness in the mucosal membranes.10 Moreover, breathing exercises have been reported to have beneficial effects in improving symptoms and optimizing pulmonary function in patients. Breathing programs have been reported to have positive effects in alleviating symptoms and optimizing pulmonary function in patients.11 Breathing exercises aim to improve the individuals breathing pattern and increase in lung expansion, they also enhance the performance of respiratory muscles thus leading towards increase in functional residual capacity, and inspiratory reserve volume.12 Breathing exercises reduces breathlessness, increase exercise capacity and improve overall well-being of a person 13,14,15,16 The physiological effect of breathing exercises comprises of increase in intra-bronchial pressure thus preventing the collapse of bronchi and leading towards increase in inspiratory and expiratory flow rate.13,15 It act by stimulating the autonomic system thereby promoting relaxation and in return improves the physiological parameters.16 Furthermore, body positioning improves the efficiency and effectiveness of both primary and accessory muscles of breathing leading to ease in dyspnea and reduction in work of breathing.17 These positions improve the ventilation perfusion ratio and utilize the gravity to remove secretions.18 Positioning decrease the ventilation demand resulting in longer expiratory time thereby preventing hyperinflation and ultimately resolving dyspnea.19 As a healthcare professional and specially a Physical Therapist we would like to ask the imminent researchers to fill this gap by conducting different surveys and trials. Through our experience we’ve found that the manoeuvres we applied have been very effective and improved the overall outcome of the patients suffering from COVID -19.

scholarly journals Integrated Clinical Experiences in a Campus Onsite Clinic: A Self-Contained Model of Physical Therapy Clinical Education

2014 ◽  
Author(s):  
Ann Wilson
Keyword(s):  
Physical Therapy ◽  
Physical Therapist ◽  
Clinical Performance ◽  
Clinical Skills ◽  
Learning Experiences ◽  
Academic Program ◽  
Full Time ◽  
Clinical Experiences ◽  
Wellness Program ◽  
Academic Knowledge

Purpose: This paper describes a self-contained model of integrated clinical experiences (ICEs) that take place during the academic portion of an entry-level physical therapist education program in a campus onsite clinic. Description of Model: Students participate in ICEs for three consecutive semesters. Students provide pro bono physical therapy services to individuals with impairments, functional limitations, or changes in physical function resulting from a variety of health conditions. In addition, students participate in an exercise/wellness program for individuals who wish to improve or maintain their current levels of fitness. The first ICE consists of second-year students observing/assisting third-year students in the onsite clinic with basic patient care skills and participation in an exercise/wellness program. Students in the second and third ICEs provide ongoing one-on-one skilled therapy for individuals with neurological or musculoskeletal diagnoses. Results: Feedback obtained from onsite clinical instructors, core academic faculty, students, and patients receiving care in the onsite clinic through group debriefings, questionnaires, and interviews is used to assess students’ readiness for full-time internships and effectiveness of the ICEs. The feedback reveals that the ICEs are meeting their intended goals. Category ratings in the “red flag” areas of the Clinical Performance Instrument (CPI) are consistently above expected levels for students completing their first full-time clinical internship. In addition, patients receiving care in the onsite clinic report a high level of satisfaction with the care provided. Conclusion/Possible Recommendations: This model provides students with an opportunity to gain clinical confidence in a realistic setting while reinforcing concepts presented in academic coursework. Providing ICEs on campus decreases reliance on clinical facilities and allows for academic program oversight of the quality of the learning experiences and early identification of students who have deficits in clinical skills and/or academic knowledge. The learning experiences provided in the onsite clinic give students a transitional experience that helps them benefit more fully from full-time internships. A potential challenge to this model is finding the space and financial resources needed to make it viable.

scholarly journals Report of a Case of Cold Urticaria Following Cryotherapy – Need for Screening for Untoward Effects of Cryotherapy in Physical Therapy Clinical Practice

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Mohanakrishnan Jagadevan ◽  
Bhanumathy Mohanakrishnan ◽  
Gopisankar Balaji ◽  
Malathi Munisamy ◽  
Salaja Murugesan ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Health Care Professionals ◽  
Physical Therapist ◽  
Care Center ◽  
Tertiary Care ◽  
Cold Urticaria ◽  
Screening Process ◽  
Cold Stimulation ◽  
Systemic Complications ◽  
First Choice

Introduction:Musculoskeletal rehabilitation is one of the frontline domains in physical therapy practice. In most countries, physical therapists prefer independent practice with referrals from general practitioners and orthopedic surgeons. Under these circumstances, the physical therapist may be the first contact professional handling these individuals who may not have adequate medical records with their personal medical history. Cryotherapy for pain relief could be the first choice of pain management opted by a musculoskeletal therapist. That is when both the therapist and the patient have to be aware of the undesirable effects of cryotherapy application and its potential local and systemic complications. The outcome of this paper could be an initiative for a standardized screening process to be incorporated into physical therapy practice. Clinical Findings:A 30-year-old man with left knee pain who underwent exercise therapy in the physiotherapy unit of a tertiary care center developed erythematous rashes around the knee following ice application. It was noted that the patient was not aware of the same in the past. The patient was attended by a dermatologist, and a diagnosis of cold urticaria was made following confirmation with cold stimulation test. Conclusion:From this study, it may be concluded that the awareness of cold-induced urticaria has to be emphasized on both patients and health care professionals. A simple screening protocol should be made mandatory in orthopedic physical therapy practice, which would suffice this purpose. Keywords: Urticaria, cryotherapy, Physical therapy

scholarly journals Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students’ perceptions of geriatrics and geriatric education in the United States

2016 ◽  
Vol 13 ◽  
pp. 35 ◽  
Author(s):  
Jennifer C. Reneker ◽  
Kyra Weems ◽  
Vincent Scaia
Keyword(s):  
Older Adults ◽  
Physical Therapy ◽  
Student Perceptions ◽  
Geriatric Patients ◽  
Physical Therapist ◽  
The United States ◽  
Community Dwelling ◽  
Effect Sizes ◽  
Entry Level ◽  
Geriatric Education

This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21–33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA. Student perceptions were collected before and after participation in the 8-week balance class. The Wilcoxon sign-ranked test was used to identify differences in perceptions after participation in the group balance class. Cohen’s d-values were calculated to measure the size of the pre-participation to post-participation effect for each measure. At the conclusion of the group class, the DPT students demonstrated an increase in positive perceptions of geriatric physical therapy in 8 measures, with small effect sizes (d=0.15–0.30). Two perceptions of geriatric physical therapy demonstrated a significant positive increase (P<0.05) with moderate effect sizes (d=0.47 and d=0.50). The students’ perceptions of geriatric education in the curriculum demonstrated a large positive effect for quality (d=1.68) and enjoyment (d=1.96). Positive changes were found in most of the perceptions of geriatrics and geriatric education after participation, suggesting that integrated clinical experiences with geriatric patients are an effective way to positively influence perceptions of physical therapist practice with older adults.

scholarly journals Patient Participation in Physical Therapy Goal Setting

2001 ◽  
Vol 81 (5) ◽  
pp. 1118-1126 ◽  
Author(s):  
Susan M Baker ◽  
Helen H Marshak ◽  
Gail T Rice ◽  
Grenith J Zimmerman
Keyword(s):  
Patient Satisfaction ◽  
Physical Therapy ◽  
Elderly Patients ◽  
Goal Setting ◽  
Patient Participation ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Assessment Instrument ◽  
Initial Examination ◽  
Goals And Objectives

Abstract Background and Purpose. An important part of treatment planning in physical therapy is effective goal setting. The Guide to Physical Therapist Practice recommends that therapists should identify the patient's goals and objectives during the initial examination in order to maximize outcomes. The purpose of this study was to examine whether therapists seek to involve patients in goal setting and, if so, what methods they use. Therapists' attitudes toward participation and patient satisfaction with the examination were also examined. Subjects and Methods. Twenty-two physical therapists audiotaped the initial examination of 73 elderly patients (X̄=76.4 years of age, SD=7.1, range=65–94). The audiotaped examinations were then scored using the Participation Method Assessment Instrument (PMAI) to determine the frequency of attempts made by therapists to involve patients in goal setting. Therapists and patients completed surveys following the examinations. Results. Therapists' use of participation methods during examinations ranged from a minimum of 1 to a maximum of 19 out of 21 possible items on the PMAI. The therapists stated that they believed that it is important to include patients in goal-setting activities and that outcomes will be improved if patients participate. Patients also indicated that participation is important to them. Discussion and Conclusion. In most cases, the therapists did not fully take advantage of the potential for patient participation in goal setting. Patient and therapist education is needed regarding methods for patient participation during initial goal-setting activities.

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