Use of Standardized Outcome Measures in Physical Therapist Practice: Perceptions and Applications

Background Standardized instruments for measuring patients' activity limitations and participation restrictions have been advocated for use by rehabilitation professionals for many years. The available literature provides few recent reports of the use of these measures by physical therapists in the United States. Objective The primary purpose of this study was to determine: (1) the extent of the use of standardized outcome measures and (2) perceptions regarding their benefits and barriers to their use. A secondary purpose was to examine factors associated with their use among physical therapists in clinical practice. Design The study used an observational design. Methods A survey questionnaire comprising items regarding the use and perceived benefits and barriers of standardized outcome measures was sent to 1,000 randomly selected members of the American Physical Therapy Association (APTA). Results Forty-eight percent of participants used standardized outcome measures. The majority of participants (>90%) who used such measures believed that they enhanced communication with patients and helped direct the plan of care. The most frequently reported reasons for not using such measures included length of time for patients to complete them, length of time for clinicians to analyze the data, and difficulty for patients in completing them independently. Use of standardized outcome measures was related to specialty certification status, practice setting, and the age of the majority of patients treated. Limitations The limitations included an unvalidated survey for data collection and a sample limited to APTA members. Conclusions Despite more than a decade of development and testing of standardized outcome measures appropriate for various conditions and practice settings, physical therapists have some distance to go in implementing their use routinely in most clinical settings. Based on the perceived barriers, alterations in practice management strategies and the instruments themselves may be necessary to increase their use.

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Referral for Imaging in Physical Therapist Practice: Key Recommendations for Successful Implementation

Physical Therapy ◽

10.1093/ptj/pzab013 ◽

2021 ◽

Author(s):

Aaron Paul Keil ◽

Charles Hazle ◽

Amma Maurer ◽

Connie Kittleson ◽

Daniel Watson ◽

...

Keyword(s):

Physical Therapy ◽

Diagnostic Imaging ◽

Physical Therapists ◽

Physical Therapist ◽

The United States ◽

Successful Implementation ◽

Program Accreditation ◽

Therapy Program ◽

Normative Practice ◽

American Physical

Abstract In recent years, the use of diagnostic imaging in physical therapist practice in the United States (US) has gained considerable interest. In several countries around the world and in the US military, patient direct referral for diagnostic imaging has been considered normative practice for decades. US physical therapy program accreditation standards now stipulate that diagnostic imaging content must be included in physical therapist educational curricula. The American Physical Therapy Association (APTA) has made efforts to pursue practice authority for imaging referral. A recent review of state practice acts and other statutory language concluded that many states have no prohibitions against physical therapists referring for imaging studies. Additionally, physical therapists can now pursue certification as musculoskeletal sonographers. In light of these advances, and with a growing number of PTs serving patients who have not yet seen another healthcare provider, it may be helpful for those who have been actively involved in the use of imaging in PT practice to provide their collective recommendations to serve as a guideline to those interested in incorporating this practice privilege. The purpose of this perspective article is to provide an overview of the key elements necessary for effective implementation of referral for imaging in physical therapist practice while emphasizing the cornerstone of effective communication.

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Creating an Interface Between the International Classification of Functioning, Disability and Health and Physical Therapist Practice

Physical Therapy ◽

10.2522/ptj.20090326 ◽

2010 ◽

Vol 90 (7) ◽

pp. 1053-1063 ◽

Cited By ~ 38

Author(s):

Reuben Escorpizo ◽

Gerold Stucki ◽

Alarcos Cieza ◽

Kandace Davis ◽

Teri Stumbo ◽

...

Keyword(s):

Clinical Practice ◽

Physical Therapists ◽

Physical Therapist ◽

International Classification ◽

International Classification Of Functioning ◽

Clinical Documentation ◽

Disability And Health ◽

Comprehensive Classification ◽

American Physical

The American Physical Therapy Association (APTA) has endorsed the International Classification of Functioning, Disability and Health (ICF) as a framework to be integrated into physical therapist practice. The ICF is a universal and inclusive platform for the understanding of health and disability and a comprehensive classification system for describing functioning. The APTA's Guide to Physical Therapist Practice was designed to guide patient management, given the different settings and health conditions that physical therapists encounter in their daily clinical practice. However, physical therapists may be unclear as to how to concretely apply the ICF in their clinical practice and to translate the application in a way that is meaningful to them and to their patients. This perspective article proposes ways to integrate the ICF and the Guide to Physical Therapist Practice to facilitate clinical documentation by physical therapists.

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Decision-Making Ability of Physical Therapists: Physical Therapy Intervention or Medical Referral

Physical Therapy ◽

10.2522/ptj.20050393 ◽

2006 ◽

Vol 86 (12) ◽

pp. 1619-1629 ◽

Cited By ~ 136

Author(s):

Diane U Jette ◽

Kerry Ardleigh ◽

Kellie Chandler ◽

Lesley McShea

Keyword(s):

Physical Therapy ◽

Confidence Interval ◽

Physical Therapists ◽

Physical Therapist ◽

Direct Access ◽

Medical Conditions ◽

Musculoskeletal Conditions ◽

Logistic Regressions ◽

American Physical ◽

Medical Referral

Abstract Background and PurposeOpponents of direct access to physical therapy argue that physical therapists may overlook serious medical conditions. More information is needed to determine the ability of physical therapists to practice safely in direct-access environments. The purpose of this study was to describe the ability of physical therapists to make decisions about the management of patients in a direct-access environment. Subjects. Of a random sample of 1,000 members of the Private Practice Section of the American Physical Therapy Association, 394 participated. Methods. A survey included 12 hypothetical case scenarios. For each case, participants determined whether they would provide intervention without referral, provide intervention and refer, or refer before intervention. The percentage of correct decisions for each group of scenarios was calculated for each participant, and participants were classified as having made correct decisions for 100% of cases or less for each group. Three sets of logistic regressions were completed to determine the characteristics of the participants in relation to the decision category. Results. The average percentages of correct decisions were 87%, 88%, and 79% for musculoskeletal, noncritical medical, and critical medical conditions, respectively. Of all participants, approximately 50% made correct decisions for all cases within each group. The odds of making 100% correct decisions if a physical therapist had an orthopedic specialization were 2.23 (95% confidence interval=1.35–3.71) for musculoskeletal conditions and 1.89 (95% confidence interval=1.14–3.15) for critical medical conditions. Discussion and Conclusion. Physical therapists with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions.

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Use of the Theoretical Domains Framework to Develop an Intervention to Improve Physical Therapist Management of the Risk of Falls After Discharge

Physical Therapy ◽

10.2522/ptj.20130412 ◽

2014 ◽

Vol 94 (11) ◽

pp. 1660-1675 ◽

Cited By ~ 13

Author(s):

Susie Thomas ◽

Shylie Mackintosh

Keyword(s):

Behavior Change ◽

Outcome Measures ◽

Best Practice ◽

Physical Therapists ◽

Physical Therapist ◽

South Australia ◽

Theoretical Domains Framework ◽

Increased Risk ◽

Risk Of Falls ◽

Practice Gap

Background and Purpose Older adults have an increased risk of falls after discharge from the hospital. Guidelines to manage this risk of falls are well documented but are not commonly implemented. The aim of this case report is to describe the novel approach of using the Theoretical Domains Framework (TDF) to develop an intervention to change the clinical behavior of physical therapists. Case Description This project had 4 phases: identifying the evidence-practice gap, identifying barriers and enablers that needed to be addressed, identifying behavior change techniques to overcome the barriers, and determining outcome measures for evaluating behavior change. Outcomes The evidence-practice gap was represented by the outcome that few patients who had undergone surgery for hip fracture were recognized as having a risk of falls or had a documented referral to a community agency for follow-up regarding the prevention of falls. Project aims aligned with best practice guidelines were established; 12 of the 14 TDF domains were considered to be relevant to behaviors in the project, and 6 behavior change strategies were implemented. Primary outcome measures included the proportion of patients who had documentation of the risk of falls and were referred for a comprehensive assessment of the risk of falls after discharge from the hospital. Discussion A systematic approach involving the TDF was useful for designing a multifaceted intervention to improve physical therapist management of the risk of falls after discharge of patients from an acute care setting in South Australia, Australia. This framework enabled the identification of targeted intervention strategies that were likely to influence health care professional behavior. Early case note audit results indicated that positive changes were being made to reduce the evidence-practice gap.

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The Evidence-based Practice Beliefs and Knowledge of Physical Therapy Clinical Instructors

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2016.1546 ◽

2016 ◽

Author(s):

Debra Bierwas ◽

Joan Leafman ◽

Donald Shaw

Keyword(s):

Evidence Based Practice ◽

Physical Therapists ◽

Physical Therapist ◽

Evidence Based ◽

Clinical Instructors ◽

Cross Sectional ◽

Negative Beliefs ◽

Specialty Certification ◽

Respondent Characteristics ◽

Practice Knowledge

Introduction: For evidence-based practice to occur in patient management or clinical instruction, a knowledge of evidence-based practice principles is needed, including how to retrieve, appraise, and apply evidence. Attitudes and beliefs are also important, since for effective change in practice to occur it must be consistent with beliefs and needs. Purpose: The purpose of this study was to examine the evidence-based practice beliefs and knowledge of physical therapist clinical instructors and to determine whether differences in self-reported beliefs or knowledge existed based upon respondent characteristics of highest degree, age, association membership, and certification. Methods: For this cross-sectional descriptive study an electronic survey was used to collect data on respondent characteristics and evidence-based practice beliefs and knowledge. Results: Respondents were 376 physical therapists who were clinical instructors. A majority of respondents reported positive beliefs about evidence-based practice: welcome questions on practice (88.5 %, n = 333); fundamental to practice (89.7%, n = 337); practice changed because of evidence (81.1%, n = 305). From rating options of poor, fair, good, very good, and excellent, respondents most often selected good to describe knowledge level: formulate question 39.6% (n = 149); retrieve evidence 39.4% (n = 148); appraise evidence 44.1% (n = 166); and apply evidence 40.4% (n = 152). Nearly half of the respondents reported as either very good or excellent the ability to apply evidence (49.4%, n = 186). There were differences in evidence-based practice beliefs (degree H = 10.152, p = .038; membership z = 4.721, p = H = 27.712, p = z = 2.188, p = .03; certification z = 4.194, p = Conclusion: Respondents frequently reported positive beliefs about evidence-based practice and the possession of evidence-based practice knowledge. However, there were respondents who reported negative beliefs such as disagreeing that new evidence is important. There were wide variations in reported evidence-based practice knowledge. The largest percentage of respondents rated knowledge as good, the middle or ‘average’ rating on the five-point scale. There were differences in evidence-based practice beliefs and knowledge between groups for highest degree, association membership, and specialty certification.

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Video-Based Motion Analysis Use: A National Survey of Orthopedic Physical Therapists

Physical Therapy ◽

10.1093/ptj/pzaa125 ◽

2020 ◽

Vol 100 (10) ◽

pp. 1759-1770

Author(s):

Craig P Hensley ◽

Devyn Millican ◽

Nida Hamilton ◽

Amy Yang ◽

Jungwha Lee ◽

...

Keyword(s):

United States ◽

Clinical Practice ◽

Treatment Outcomes ◽

Motion Analysis ◽

Online Survey ◽

Physical Therapists ◽

Physical Therapist ◽

Reliability And Validity ◽

The United States ◽

Future Research

Abstract Objectives Motion analysis is performed by physical therapists to assess and improve movement. Two-dimensional video-based motion analysis (VBMA) is available for smartphones/tablets and requires little to no equipment or cost. Research on VBMA use in clinical practice is limited. The purpose of this study was to examine the current use of VBMA in orthopedic physical therapist practice. Methods Members of the Academy of Orthopaedic Physical Therapy completed an online survey. Questions examined frequency of VBMA use, reasons for use, facilitators/barriers, device/apps used, practice patterns, other certificates/degrees, and demographic information. Results Among the final analysis sample of 477 respondents, 228 (47.8%) use VBMA. Of 228 VBMA users, 91.2% reported using it for ≤25% of their caseload, and 57.9% reported using their personal device to capture movement. Reasons for using VBMA included visual feedback for patient education (91.7%), analysis of movement (91.2%), and assessment of progress (51.8%). Barriers to use included lack of device/equipment (48.8%), lack of space (48.6%), and time restraint (32.1%). Those with ≤20 years of clinical experience (odds ratio [OR] = 1.83, 95% CI = 1.21–2.76), residency training (OR = 2.49, 95% CI = 1.14–5.43), and fellowship training (OR = 2.97, 95% CI = 1.32–6.66), and those from the West region of the United States (OR = 1.66, 95% CI = 1.07–2.56) were more likely to use VBMA. Conclusions More than 50% of surveyed orthopedic physical therapists do not use VBMA in clinical practice. Future research should be directed toward assessing reliability and validity of VBMA use by smartphones, tablets, and apps and examining whether VBMA use enhances treatment outcomes. Data security, patient confidentiality, and integration into the electronic medical record should be addressed. Impact This study is the first to our knowledge to describe the use of VBMA in orthopedic physical therapist practice in the United States. It is the first step in understanding how VBMA is used and might be used to enhance clinical assessment and treatment outcomes.

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Physical Therapist Management of Total Knee Arthroplasty

Physical Therapy ◽

10.1093/ptj/pzaa099 ◽

2020 ◽

Vol 100 (9) ◽

pp. 1603-1631 ◽

Cited By ~ 2

Author(s):

Diane U Jette ◽

Stephen J Hunter ◽

Lynn Burkett ◽

Bud Langham ◽

David S Logerstedt ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Physical Therapists ◽

Physical Therapist ◽

Guideline Development ◽

Clinical Information ◽

Guideline Development Group ◽

Total Knee ◽

American Physical ◽

Development Group

Abstract A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.

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Performance-based outcome measures are associated with cadence variability during community ambulation among individuals with a transtibial amputation

Prosthetics and Orthotics International ◽

10.1177/0309364620927608 ◽

2020 ◽

Vol 44 (4) ◽

pp. 215-224

Author(s):

Emma Haldane Beisheim ◽

Elisa Sarah Arch ◽

John Robert Horne ◽

Jaclyn Megan Sions

Keyword(s):

Physical Performance ◽

Outcome Measures ◽

Gait Speed ◽

The United States ◽

Clinical Settings ◽

Walk Test ◽

Community Based ◽

Transtibial Amputation ◽

Community Ambulation ◽

10 Meter Walk Test

Background: In the United States, Medicare Functional Classification Level (K-level) guidelines require demonstration of cadence variability to justify higher-level prosthetic componentry prescription; however, clinical assessment of cadence variability is subjective. Currently, no clinical outcome measures are associated with cadence variability during community ambulation. Objectives: Evaluate whether physical performance, i.e. 10-meter Walk Test (10mWT)-based walking speeds, L-Test, and Figure-of-8 Walk Test scores, is associated with community-based cadence variability among individuals with a transtibial amputation. Study design: Cross-sectional. Methods: Forty-nine participants, aged 18–85 years, with a unilateral transtibial amputation were included. Linear regression models were conducted to determine whether physical performance was associated with cadence variability (a unitless calculation from FitBit® OneTM minute-by-minute step counts), while controlling for sex, age, and time since amputation ( p ⩽ .013). Results: Beyond covariates, self-selected gait speed explained the greatest amount of variance in cadence variability (19.2%, p < .001). Other outcome measures explained smaller, but significant, amounts of the variance (11.1–17.1%, p = .001–.008). For each 0.1 m/s-increase in self-selected and fast gait speeds, or each 1-s decrease in L-Test and F8WT time, community-based cadence variability increased by 1.76, 1.07, 0.39, and 0.79, respectively ( p < .013). Conclusions: In clinical settings, faster self-selected gait speed best predicted increased cadence variability during community ambulation. Clinical relevance The 10-meter Walk Test may be prioritized during prosthetic evaluations to provide objective self-selected walking speed data, which informs the assessment of cadence variability potential outside of clinical settings.

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The Use of Yoga by Physical Therapists in the United States

International Journal of Yoga Therapy ◽

10.17761/1531-2054-27.1.69 ◽

2017 ◽

Vol 27 (1) ◽

pp. 69-79 ◽

Cited By ~ 1

Author(s):

Mary E. Wims ◽

Shayla M. McIntyre ◽

Ann York ◽

Laura G. Covill

Keyword(s):

United States ◽

Physical Therapy ◽

Physical Therapists ◽

The United States ◽

Primary Concern ◽

Health And Wellness ◽

Clinical Practices ◽

Post Discharge ◽

Electronic Communications ◽

American Physical

Abstract How physical therapists (PTs) in the United States currently use yoga in their clinical practices is unknown. The purpose of this study was to determine how PTs in the United States view yoga as a physical therapy (PT) tool and how PTs use yoga therapeutically. The authors conducted a 24-item survey via electronic communications of the Geriatric, Orthopedic, Pediatric, and Women's Health Sections of the American Physical Therapy Association. Participants (n = 333) from 47 states and the District of Columbia replied. Reported use of therapeutic yoga among participants was high (70.6%). Of those participants, nearly a third use asana and pranayama only. Most participants using therapeutic yoga also include additional mindfulness-related elements such as sensory awareness, concentration/focus, and/or meditation. Most participants learned about yoga through personal experiences, with many participants citing lack of familiarity in using yoga in PT practice. Safety is the primary concern of participants when recommending yoga to patients as an independent health and wellness activity. Interdisciplinary communication between PTs, yoga therapists, and yoga teachers is warranted to address the post-discharge needs of clients. Healthcare changes have required PTs to adapt to a biopsychosocial-spiritual model (BPSS) for improved patient outcomes. Therapeutic yoga may provide an opportunity for PTs to expand their role in health and wellness and chronic disease management. There is opportunity for continuing education in therapeutic yoga for PTs.

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Administration and Management Skills Needed by Physical Therapist Graduates in 2010: A National Survey

Physical Therapy ◽

10.2522/ptj.20060003 ◽

2007 ◽

Vol 87 (3) ◽

pp. 261-281 ◽

Cited By ~ 5

Author(s):

D Sue Schafer ◽

Rosalie B Lopopolo ◽

Kathleen A Luedtke-Hoffmann

Keyword(s):

Physical Therapy ◽

Skill Acquisition ◽

Financial Analysis ◽

Physical Therapists ◽

Physical Therapist ◽

Management Skills ◽

Health Care Environment ◽

Doctor Of Physical Therapy ◽

Skill Groups ◽

American Physical

Background and Purpose Administration and management (A&M) skills are essential to physical therapist practice. This study identified which A&M skills will be most critical for future Doctor of Physical Therapy (DPT) graduates to possess upon entry into clinical practice. Subjects and Methods Using a 7-point scale, 435 randomly selected American Physical Therapy Association members (physical therapists) rated 121 A&M skills based on expectation of the level of independence required by a new DPT graduate. Results No differences among respondents based on role, work setting, or experience were found, so the data were combined for factor analyses, producing 16 A&M skill groups. The most independence was expected in skills related to self-management, compliance with rules, ethical behavior, and insurance coding. Skills requiring the most assistance were marketing and strategic planning, financial analysis and budgeting, and environmental assessment. Discussion and Conclusion This study has identified the level of independence for the A&M skills needed by new DPT graduates, provided empirical evidence suggesting which A&M skills should be included in DPT curricula, and suggested a pattern of A&M skill acquisition that applies first to the new therapist and the patient, then to the organization, and finally to the health care environment.

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