Evaluating the Uptake and Acceptability of Standardized Postoperative Rehabilitation Guidelines Using an Online Knowledge Translation Approach

Abstract Background Providing physical therapists with evidence-based and consensus-derived guidelines to manage postoperative shoulder patients is essential; these guidelines should be readily available and provide clinically applicable information. Knowledge translation (KT) initiatives that encourage interaction between clinicians and researchers, that have multifaceted components and use a variety of strategies, can significantly change practice. Objective The objective of this study was to determine the uptake and acceptability of standardized postoperative shoulder guidelines with an accompanying online KT resource through evaluation of website analytics and a quantitative survey. Design A multi-pronged approach was used to assess uptake and acceptability of the guidelines and online KT resource. Methods Website analytics of usage and geographical location of users was measured as were physical therapist survey responses. Results Website analytics revealed that 5406 individuals used the online resource between October 2012 and September 2013 with the average visit lasting 8 minutes; only 47% of users were within the guideline developers’ surgical referral region. Physical therapists who used the new shoulder guidelines were very satisfied or satisfied (96%) with the guidelines, reporting they promoted patient-specific clinical decision-making extremely or very well (68%). They viewed the online KT resource positively, with 79% rating it as “very useful” or “quite useful.” Physical therapists from regions beyond those expected to use the new shoulder guidelines were also aware of the website and also rated it as very useful. Limitations The survey sample was relatively small and did not directly assess patient outcomes. Conclusions An online KT web resource developed in conjunction with standardized postoperative shoulder guidelines was perceived as useful based on website analytics and survey responses. Active KT strategies such as this can improve uptake and dissemination of best practice in physical therapy.

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Value-Based Care for Musculoskeletal Pain: Are Physical Therapists Ready to Deliver?

Physical Therapy ◽

10.1093/ptj/pzz171 ◽

2019 ◽

Vol 100 (4) ◽

pp. 621-632 ◽

Cited By ~ 1

Author(s):

Trevor A Lentz ◽

Adam P Goode ◽

Charles A Thigpen ◽

Steven Z George

Keyword(s):

Health Care ◽

Physical Therapy ◽

Musculoskeletal Pain ◽

Clinical Decision Making ◽

Physical Therapists ◽

Physical Therapist ◽

Great Promise ◽

Health Care Environment ◽

Early Physical Therapy ◽

Analytical Approaches

Abstract Early physical therapy models hold great promise for delivering high-value care for individuals with musculoskeletal pain. However, existing physical therapist practice and research standards are misaligned with value-based principles, which limits the potential for growth and sustainability of these models. This Perspective describes how the value proposition of early physical therapy can be improved by redefining harm, embracing a prognostic approach to clinical decision making, and advocating for system-wide guideline-adherent pain care. It also outlines the need to adopt a common language to describe these models and embrace new, rigorous study designs and analytical approaches to better understand where and how early physical therapy delivers value. The goal is to define a clear path forward to ensure physical therapists are aligned within health care systems to deliver on the American Physical Therapy Association’s vision of high-value care in a rapidly changing health care environment.

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Physical Therapy Intervention for People With Huntington Disease

Physical Therapy ◽

10.2522/ptj.20070346 ◽

2008 ◽

Vol 88 (7) ◽

pp. 820-831 ◽

Cited By ~ 31

Author(s):

Monica E Busse ◽

Hanan Khalil ◽

Lori Quinn ◽

Anne E Rosser

Keyword(s):

Physical Therapy ◽

Huntington Disease ◽

Clinical Decision Making ◽

Clinical Symptoms ◽

Physical Therapists ◽

Physical Therapist ◽

Clinical Care ◽

Future Research ◽

Therapy Intervention ◽

Physical Therapy Intervention

Background and PurposeThe clinical symptoms of Huntington disease (HD) include progressive movement disorders, cognitive deficits, and behavioral changes, all of which affect an individual's ability to participate in activities of daily living. To date, very few quantitative or qualitative studies have been conducted to guide physical therapists working with people with HD. The objective of this study was to characterize current physical therapist practice for people with HD, thus informing the development of standardized clinical care and future research studies.Subjects and MethodsConsultation with physical therapists working with people with HD was undertaken in the form of mailed questionnaires (n=49) and semistructured interviews (n=8). The development of the interview schedule was aided by consideration of the data obtained from the questionnaires. Themes identified from the interviews were considered in light of published literature and questionnaire responses.ResultsThe main issues that emerged from the interviews were classified into 3 subthemes: (1) there is insufficient use of routine physical therapy–related outcome measures at different stages of HD, (2) there is underutilization of physical therapy services in managing HD (particularly in the early stages), and (3) the management of falls and mobility deficit progression is a key treatment aim for people with HD.Discussion and ConclusionA conceptual framework for physical therapy intervention in HD was developed on the basis of the themes that emerged from the data in this study. Such a framework has utility for complex, progressive conditions such as HD and may facilitate clinical decision making and standardization of practice and affect the development of future physical therapy trials.

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Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline

Physical Therapy ◽

10.2522/ptj.20150264 ◽

2016 ◽

Vol 96 (2) ◽

pp. 143-166 ◽

Cited By ~ 15

Author(s):

Ellen Hillegass ◽

Michael Puthoff ◽

Ethel M. Frese ◽

Mary Thigpen ◽

Dennis C. Sobush ◽

...

Keyword(s):

Decision Making ◽

At Risk ◽

Clinical Practice ◽

Venous Thromboembolism ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Clinical Decision Making ◽

Physical Therapists ◽

Physical Therapist ◽

Patients At Risk

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT.

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How Do Physical Therapists Approach Management of People With Early Knee Osteoarthritis? A Qualitative Study

Physical Therapy ◽

10.1093/ptj/pzz164 ◽

2019 ◽

Vol 100 (2) ◽

pp. 295-306 ◽

Cited By ~ 1

Author(s):

Crystal MacKay ◽

Gillian A Hawker ◽

Susan B Jaglal

Keyword(s):

Knee Osteoarthritis ◽

Weight Management ◽

Clinical Decision Making ◽

Physical Therapists ◽

Physical Therapist ◽

Continuing Professional Development ◽

Clinical Decision ◽

Therapeutic Interventions ◽

Evidence Based ◽

Knee Oa

Abstract Background Knee osteoarthritis (OA) is a leading cause of disability. There is increasing emphasis on initiating treatment earlier in the disease. Physical therapists are central to the management of OA through the delivery of exercise programs. There is a paucity of research on physical therapists’ perceptions and clinical behaviors related to early knee OA management. Objective The study aimed to explore how physical therapists approached management of early knee OA, with a focus on evidence-based strategies. This is an important first step to begin to optimize care by physical therapists for this population. Design We used a qualitative, descriptive research design. Methods Semistructured interviews were conducted with 33 physical therapists working with people with knee symptoms and/or diagnosed knee OA in community or outpatient settings in Canada. Data were analyzed using thematic analysis. Results Five main themes were constructed: (1) Physical therapists’ experience and training: clinical experiences and continuing professional development informed clinical decision-making. (2) Tailoring treatment from the physical therapist “toolbox:” participants described their toolbox of therapeutic interventions, highlighting the importance of tailoring treatments to people. (3) The central role of exercise and physical activity in management: exercise was consistently recommended by participants. (4) Variability in support for weight management: there was variation related to how participants addressed weight management. (5) Facilitating “buy-in” to management: physical therapists used a range of strategies to gain “buy-in.” Limitations Participants were recruited through a professional association specializing in orthopedic physical therapy and worked an average of 21 years. Conclusions Participants’ accounts emphasized tailoring of interventions, particularly exercises, which is an evidence-based strategy for OA. Findings illuminated variations in management that warrant further exploration to optimize early intervention (eg, weight management, behavior change techniques).

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The Patient Goal Priority Questionnaire Is Moderately Reproducible in People With Persistent Musculoskeletal Pain

Physical Therapy ◽

10.2522/ptj.20090030 ◽

2009 ◽

Vol 89 (11) ◽

pp. 1226-1234 ◽

Cited By ~ 9

Author(s):

Pernilla Åsenlöf ◽

Kim Siljebäck

Keyword(s):

Musculoskeletal Pain ◽

Physical Therapists ◽

Physical Therapist ◽

Psychometric Evaluation ◽

Self Report ◽

Patient Specific ◽

Priority List ◽

Retest Reliability ◽

Clinically Significant ◽

Test Retest Reliability

BackgroundThe Patient Goal Priority Questionnaire (PGPQ) is a patient-specific measure for identification of behavioral goals and evaluation of clinically significant changes. The use of such a measure in clinical settings and research requires that identified goals be consistent over time. Self-reports of behaviors related to the goals should be reliably estimated.ObjectiveThe purpose of this study was to estimate chance-corrected agreement and test-retest reliability of the PGPQ. Chance-corrected agreement between the PGPQ and a similar therapist-guided goal identification tool, the Patient Goal Priority List (PGPL), also was estimated.DesignA correlative and prospective design with 3 measurement points (M1, M2, and M3) was used in the study.MethodsFifty-four people who consulted physical therapists in primary care for persistent musculoskeletal pain were included in the study. Analyses of chance-corrected agreement and test-retest reliability of the PGPQ were done at M1 and M2. Chance-corrected agreement between procedures (PGPQ and PGPL) also was analyzed at M1 and M3.ResultsThe percentage of agreement on content of the priority lists of the PGPQ at M1 and M2 was 52%. Cohen kappa values for agreement of rankings ranged between .47 and .64. Test-retest reliability coefficients for the self-report scales of the PGPQ ranged from .35 to .81. Chance-corrected agreement decreased when physical therapists were involved in the goal identification process using the PGPL (kappa=.08–.46).LimitationsVarying item content and a small, heterogeneous sample possibly increased variation and the standard error of measurements. The feasibility of using traditional approaches to psychometric evaluation of patient-specific measures is questionable.ConclusionsChance-corrected agreement and test-retest reliability of the PGPQ were moderate. Involving a physical therapist in the goal identification procedure possibly introduced further bias. The size of the measurement error must be taken into account when using the PGPQ for estimations of clinically important changes.

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Implementation of Measurement Instruments in Physical Therapist Practice: Development of a Tailored Strategy

Physical Therapy ◽

10.2522/ptj.20090105 ◽

2010 ◽

Vol 90 (6) ◽

pp. 953-961 ◽

Cited By ~ 41

Author(s):

J.G. Anita Stevens ◽

Anna J.M.H. Beurskens

Keyword(s):

Physical Therapy ◽

Physical Therapists ◽

Physical Therapist ◽

Barriers And Facilitators ◽

Patient Specific ◽

Planning Model ◽

Measurement Instruments ◽

Implementation Plan ◽

Future Studies ◽

Practice Organization

Background and PurposeThe use of measurement instruments has become a major issue in physical therapy, but their use in daily practice is infrequent. The aims of this case report were to develop and evaluate a plan for the systematic implementation of 2 measurement instruments frequently recommended in Dutch physical therapy clinical guidelines: the Patient-Specific Complaints instrument and the Six-Minute Walk Test.Case DescriptionA systematic implementation plan was used, starting with a problem analysis of aspects of physical therapist practice. A literary search, structured interviews, and sounding board meetings were used to identify barriers and facilitators. Based on these factors, various strategies were developed through the use of a planning model for the process of change.OutcomesBarriers and facilitators were revealed in various domains: physical therapists' competence and attitude (knowledge and resistance to change), organization (policy), patients (different expectations), and measurement instruments (feasibility). The strategies developed were adjustment of the measurement instruments, a self-analysis list, and an education module. Pilot testing and evaluation of the implementation plan were undertaken. The strategies developed were applicable to physical therapist practice. Self-analysis, education, and attention to the practice organization made the physical therapists aware of their actual behavior, increased their knowledge, and improved their attitudes toward and their use of measurement instruments.DiscussionThe use of a planning model made it possible to tailor multifaceted strategies toward various domains and phases of behavioral change. The strategies will be further developed in programs of the Royal Dutch Society for Physical Therapy. Future studies should examine the use of measurement instruments as an integrated part of the process of clinical reasoning. The focus of future studies should be directed not only toward physical therapists but also toward the practice organization and professional associations.

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The Contribution of Conceptual Frameworks to Knowledge Translation Interventions in Physical Therapy

Physical Therapy ◽

10.2522/ptj.20130483 ◽

2015 ◽

Vol 95 (4) ◽

pp. 630-639 ◽

Cited By ~ 28

Author(s):

Anne Hudon ◽

Mathieu-Joël Gervais ◽

Matthew Hunt

Keyword(s):

Physical Therapy ◽

Knowledge Translation ◽

Physical Therapists ◽

Physical Therapist ◽

Positive Impact ◽

Conceptual Frameworks ◽

Research Findings ◽

Potential Benefits ◽

Practice Gap ◽

Knowledge Translation Interventions

There is growing recognition of the importance of knowledge translation activities in physical therapy to ensure that research findings are integrated into clinical practice, and increasing numbers of knowledge translation interventions are being conducted. Although various frameworks have been developed to guide and facilitate the process of translating knowledge into practice, these tools have been infrequently used in physical therapy knowledge translation studies to date. Knowledge translation in physical therapy implicates multiple stakeholders and environments and involves numerous steps. In light of this complexity, the use of explicit conceptual frameworks by clinicians and researchers conducting knowledge translation interventions is associated with a range of potential benefits. This perspective article argues that such frameworks are important resources to promote the uptake of new evidence in physical therapist practice settings. Four key benefits associated with the use of conceptual frameworks in designing and implementing knowledge translation interventions are identified, and limits related to their use are considered. A sample of 5 conceptual frameworks is evaluated, and how they address common barriers to knowledge translation in physical therapy is assessed. The goal of this analysis is to provide guidance to physical therapists seeking to identify a framework to support the design and implementation of a knowledge translation intervention. Finally, the use of a conceptual framework is illustrated through a case example. Increased use of conceptual frameworks can have a positive impact on the field of knowledge translation in physical therapy and support the development and implementation of robust and effective knowledge translation interventions that help span the research-practice gap.

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Novice and Experienced Physical Therapist Clinicians: A Comparison of How Reflection Is Used to Inform the Clinical Decision-Making Process

Physical Therapy ◽

10.2522/ptj.20090077 ◽

2010 ◽

Vol 90 (1) ◽

pp. 75-88 ◽

Cited By ~ 76

Author(s):

Susan Flannery Wainwright ◽

Katherine F. Shepard ◽

Laurinda B. Harman ◽

James Stephens

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Structure Learning ◽

Physical Therapists ◽

Physical Therapist ◽

Inpatient Rehabilitation ◽

Clinical Decision ◽

Decision Making Process ◽

Multiple Data ◽

Reflection On Action

Background Prior experience informs clinical decision making and shapes how reflection is used by novice and experienced physical therapist clinicians. Objectives The aims of this research were: (1) to determine the types and extent of reflection that informs the clinical decision-making process and (2) to compare the use of reflection to direct and assess clinical decisions made by novice and experienced physical therapists. Design Qualitative research methods using grounded theory were used to gain insight into how physical therapists use reflection to inform clinical decision making. Methods Three participant pairs (each pair consisting of one novice and one experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries of each participant provided the basis for within- and across-case analysis. Credibility of these results was established through member check of the case summaries, presentation of low-inference data, and triangulation across multiple data sources and within and across the participant groups. Results Although all participants engaged in reflection-on-action, the experienced participants did so with greater frequency. The experienced participants were distinguished by their use of reflection-in-action and self-assessment during therapist-patient interactions. An intermediate effect beyond novice practice was observed. Conclusions The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities to facilitate clinical decision-making abilities and the development of the skills necessary for reflection in students and novice practitioners.

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A Qualitative Comparison of Reassurance Approaches Used by Physical Therapists to Address Fears and Concerns of Patients With Nonspecific Neck Pain and Whiplash-Associated Disorders: An Online Survey

Physical Therapy ◽

10.1093/ptj/pzaa058 ◽

2020 ◽

Vol 100 (7) ◽

pp. 1132-1141

Author(s):

Alma Viviana Silva Guerrero ◽

Jenny Setchell ◽

Annicke Maujean ◽

Michele Sterling

Keyword(s):

Psychological Distress ◽

Neck Pain ◽

Online Survey ◽

Physical Therapists ◽

Physical Therapist ◽

Qualitative Comparison ◽

Convenience Sampling ◽

Whiplash Associated Disorders ◽

Survey Responses ◽

Constant Comparative Analysis

Abstract Objectives The study aimed to identify and compare (1) what physical therapists perceive to be the main concerns, fears, and worries that patients with whiplash-associated disorders (WAD) and nontraumatic neck pain (NTNP) have as a result of their condition, and (2) the strategies used by physical therapists to address these fears and concerns. Methods Using convenience sampling, 30 physical therapists completed 2 online open-ended surveys. The responses were analyzed using 2 descriptive analytic methods (thematic analysis and constant comparative analysis), and then themes were examined for areas of convergence and divergence. Results Four similar themes for both neck pain groups were produced from our analysis of the survey responses: (1) interference with daily life, (2) concerns related to pain, (3) psychological distress, and (4) ``When I will recover?'' Subthemes differed between the groups. For example, the theme “psychological distress” had subthemes of anger and thoughts about no resolution for the WAD group, whereas for the NTNP group, subthemes were anxiety and uncertainty. The only divergent theme was (5) fear avoidance, present in the NTNP group only. Analysis of physical therapist strategies identified 3 consistent themes and 5 divergent themes across the 2 groups. Conclusions Physical therapists described a wealth of reassurance strategies for individuals with NTNP and WAD. There were several shared themes but also some discordant ones. Reassurance is multifactorial and needs to be nuanced and not prescriptive. Impact These qualitative findings may be key to inform the differentiated content of training programs for physical therapists delivering reassurance for these 2 populations.

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Factors That Influence the Clinical Decision Making of Novice and Experienced Physical Therapists

Physical Therapy ◽

10.2522/ptj.20100161 ◽

2011 ◽

Vol 91 (1) ◽

pp. 87-101 ◽

Cited By ~ 76

Author(s):

Susan Flannery Wainwright ◽

Katherine F. Shepard ◽

Laurinda B. Harman ◽

James Stephens

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Structure Learning ◽

Physical Therapists ◽

Physical Therapist ◽

Inpatient Rehabilitation ◽

Clinical Decision ◽

Novice Learners ◽

Multiple Data ◽

Insight Into

Background The depth and breadth of prior experience informs clinical decision making in novice and experienced physical therapist clinicians. Objectives The aims of this research were to identify differences in clinical decision-making abilities and processes between novice and experienced physical therapist clinicians and to develop a model of the factors that influence clinical decision making. Design Qualitative research methods and grounded theory were used to gain insight into the factors and experiences that inform clinical decision making. Methods Three participant pairs (each pair consisted of 1 novice physical therapist and 1 experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries from each participant provided the basis for within- and across-case analyses. The credibility of the results was established through checking of the case summaries by the participants, presentation of low-inference data, and triangulation across multiple data sources and within and across participant groups. Results The factors that influenced clinical decision making were categorized as informative or directive. Novice participants relied more on informative factors, whereas experienced participants were more likely to rely on directive factors. An intermediate effect beyond novice practice was observed. Conclusions The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities for students and novice learners with the aim of facilitating the development of skills and abilities consistent with expert clinical decision making.

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