scholarly journals Introduction to the GRADE Approach for Guideline Development: Considerations for Physical Therapist Practice

2014 ◽  
Vol 94 (11) ◽  
pp. 1652-1659 ◽  
Author(s):  
Tricia M. Austin ◽  
Randy R. Richter ◽  
Chris A. Sebelski
Keyword(s):  
Health Care ◽  
International Organizations ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Guideline Development ◽  
Care Delivery ◽  
Assessment Development ◽  
Diagnosis And Prognosis ◽  
Use Of Resources ◽  
Grade Approach

BackgroundPractice guidelines (guidelines) have an increasing role in health care delivery and are being published more frequently. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is an approach for guideline development. The GRADE approach has been adopted by multiple national and international organizations producing guidelines related to physical therapist care.ObjectiveThe purpose of this article is to introduce physical therapists to the GRADE approach for guideline development.ResultsGRADE provides a consistent approach for guideline development and transparency in the communication of how the guidelines were developed and how the recommendations were reached, leading to informed choices by patients, clinicians, and policy makers in health care. GRADE leads to a clear distinction between the strength of the evidence and the recommendation. Both the direction (for or against) and the strength (weak or strong) of the recommendation are considered. For determining the strength of the recommendation, GRADE takes into account the quality of evidence, the balance of benefit and harm, uncertainty about or variability in patients' values and preferences, and uncertainty about whether the intervention is a wise use of resources.LimitationsThe GRADE approach has been used primarily with interventions and clinical questions and less often with questions related to diagnosis and prognosis.ConclusionsThe frequency of publication of guidelines is increasing. To make informed choices in the health care system, physical therapists should understand how guidelines are developed. The GRADE approach has been adopted by national and international organizations that produce guidelines relevant to physical therapist practice. Understanding the GRADE approach will enable physical therapists to make informed clinical choices.

The Physical Therapy and Society Summit (PASS) Meeting: Observations and Opportunities

2010 ◽  
Vol 90 (11) ◽  
pp. 1555-1567 ◽  
Author(s):  
Colleen M. Kigin ◽  
Mary M. Rodgers ◽  
Steven L. Wolf
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Care Delivery ◽  
Cost Effective ◽  
Steering Committee ◽  
Health Care Team ◽  
Health Care Environment ◽  
Care Needs

The construct of delivering high-quality and cost-effective health care is in flux, and the profession must strategically plan how to meet the needs of society. In 2006, the House of Delegates of the American Physical Therapy Association passed a motion to convene a summit on “how physical therapists can meet current, evolving, and future societal health care needs.” The Physical Therapy and Society Summit (PASS) meeting on February 27–28, 2009, in Leesburg, Virginia, sent a clear message that for physical therapists to be effective and thrive in the health care environment of the future, a paradigm shift is required. During the PASS meeting, participants reframed our traditional focus on the physical therapist and the patient/client (consumer) to one in which physical therapists are an integral part of a collaborative, multidisciplinary health care team with the health care consumer as its focus. The PASS Steering Committee recognized that some of the opportunities that surfaced during the PASS meeting may be disruptive or may not be within the profession's present strategic or tactical plans. Thus, adopting a framework that helps to establish the need for change that is provocative and potentially disruptive to our present care delivery, yet prioritizes opportunities, is a critical and essential step. Each of us in the physical therapy profession must take on post–PASS roles and responsibilities to accomplish the systemic change that is so intimately intertwined with our destiny. This article offers a perspective of the dynamic dialogue and suggestions that emerged from the PASS event, providing further opportunities for discussion and action within our profession.

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

2019 ◽  
Vol 100 (4) ◽  
pp. 621-632 ◽  
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.

scholarly journals Benefits of Musculoskeletal Physical Therapy in Emergency Departments: A Systematic Review

2019 ◽  
Vol 99 (9) ◽  
pp. 1150-1166 ◽  
Author(s):  
Eveline Matifat ◽  
Marianne Méquignon ◽  
Caitriona Cunningham ◽  
Catherine Blake ◽  
Oma Fennelly ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Usual Care ◽  
Health Care Providers ◽  
Emergency Departments ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Current Evidence ◽  
Care Providers ◽  
High Quality

Abstract Background Over the past few decades, physical therapists have emerged as key health care providers in emergency departments (EDs), especially for patients with musculoskeletal disorders (MSKD). Purpose The purpose of this review was to update the current evidence regarding physical therapist care for patients with MSKD in EDs and to update current recommendations for these models of care. Data Sources Systematic searches were conducted in 5 bibliographic databases. Study Selection The studies selected presented quantitative data related to the care of patients with MSKD by physical therapists in an ED setting. Data Extraction Raters reviewed studies and used the Effective Public Health Practice Project Quality Assessment Tool to assess their methodological quality. Data Synthesis Fifteen studies were included. Two studies, 1 of weak and 1 of strong quality, demonstrated that physical therapist care in EDs was as effective as or more effective than usual medical care for pain reduction, and 6 studies of varying quality reported that physical therapist care in EDs was as effective as usual care in EDs in reducing disability. Eight studies of varying quality reported that physical therapist care could significantly reduce waiting time in EDs. Four studies of varying quality reported that physical therapists ordered no more, or even fewer, medical images than physicians. In terms of health care costs, 2 studies of moderate to high quality found no significant differences in costs between physical therapist care and usual care in EDs. Finally, 6 studies of varying quality reported that patients were as satisfied or more satisfied with physical therapist care as with usual medical care in EDs. Limitations The roles of physical therapists in EDs vary depending on the setting, legislation, and training of providers. Only a limited number of high-quality studies were identified. Conclusions Although the quality of the evidence is heterogeneous, physical therapist care for patients with MSKD in EDs may be beneficial.

scholarly journals The Continuum of Care for Individuals With Lifelong Disabilities: Role of the Physical Therapist

2014 ◽  
Vol 94 (7) ◽  
pp. 1043-1053 ◽  
Author(s):  
Margo N. Orlin ◽  
Nancy A. Cicirello ◽  
Anne E. O'Donnell ◽  
Antonette K. Doty
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Health Care Services ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Functional Limitations ◽  
Insurance Coverage ◽  
Comprehensive Health ◽  
Earning Power ◽  
Smooth Transitions

Many individuals with lifelong disabilities (LLDs) of childhood onset are living longer, participating in adult roles, and seeking comprehensive health care services, including physical therapy, with greater frequency than in the past. Individuals with LLDs have the same goals of health and wellness as those without disabilities. Aging with a chronic LLD is not yet well understood; however, impairments such as pain, fatigue, and osteoporosis often present earlier than in adults who are aging typically. People with LLDs, especially those living with developmental disabilities such as cerebral palsy, myelomeningocele, Down syndrome, and intellectual disabilities, frequently have complex and multiple body system impairments and functional limitations that can: (1) be the cause of numerous and varied secondary conditions, (2) limit overall earning power, (3) diminish insurance coverage, and (4) create unique challenges for accessing health care. Collaboration between adult and pediatric practitioners is encouraged to facilitate smooth transitions to health practitioners, including physical therapists. A collaborative client-centered emphasis to support the transition to adult-oriented facilities and promote strategies to increase accessibility should become standard parts of examination, goal setting, and intervention. This perspective article identifies barriers individuals with selected LLDs experience in accessing health care, including physical therapy. Strategies are suggested, including establishment of niche practices, physical accessibility improvement, and inclusion of more specific curriculum content in professional (entry-level) doctorate physical therapy schools.

scholarly journals Reaching the Masses: Physical Therapist Students Learn to Use YouTube to Share Clinical Information with Patients and the Public

2010 ◽  
Author(s):  
Wayne Moore
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Health Care Providers ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Clinical Skill ◽  
Care Providers ◽  
Physical Therapist Students ◽  
Educational Videos ◽  
Students Attitudes

Purposes: This pilot study (1) assessed physical therapist students’ attitudes toward using YouTube to share health-related videos on the Internet, and (2) determined whether a cohort of physical therapist students would use YouTube, or similar technologies, to share educational information with other health care providers and health care consumers once they enter practice. Methods: A cohort of 28-second-year Doctor of Physical Therapy students completed a project to produce and share educational videos on YouTube. Students, working in small groups, selected a clinical skill introduced and practiced during the Cardiopulmonary Physical Therapy course as the focus of their videos. A survey completed at the conclusion of the project collected data about students’ attitudes and experiences regarding the use of YouTube. Results: Tabulation of students’ responses revealed that 85% of the students enjoyed making videos and 96% of the students felt that physical therapists should share physical therapy-related information with the largest possible audience. Nineteen percent of the students reported that they are likely to share additional videos online. Conclusion:YouTube and other online video sites allow physical therapists to reach a large audience of people interested in the services and education they provide. However, some students may be reluctant to take advantage of this relatively new technology. Future research may focus on the relationship between the obligation students feel to produce educational videos and their reported reluctance to produce educational videos once they enter clinical practice.

scholarly journals Physical Therapist Management of Total Knee Arthroplasty

2020 ◽  
Vol 100 (9) ◽  
pp. 1603-1631 ◽  
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.

scholarly journals Physical Therapy in the Emergency Department: Development of a Novel Practice Venue

2010 ◽  
Vol 90 (3) ◽  
pp. 420-426 ◽  
Author(s):  
Debra Fleming-McDonnell ◽  
Sylvia Czuppon ◽  
Susan S. Deusinger ◽  
Robert H. Deusinger
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Functional Mobility ◽  
Urban Hospital ◽  
American Health Care System ◽  
Early Implementation ◽  
Wide Range

Background and Purpose The American Physical Therapy Association's Vision 2020 advocates that physical therapists be integral members of health care teams responsible for diagnosing and managing movement and functional disorders. This report details the design and early implementation of a physical therapist service in the emergency department (ED) of a large, urban hospital and presents recommendations for assessing the effectiveness of physical therapists in this setting. Case Description Emergency departments serve multiple purposes in the American health care system, including care of patients with non–life-threatening illnesses. Physical therapists have expertise in screening for problems that are not amenable to physical therapy and in addressing a wide range of acute and chronic musculoskeletal pain problems. This expertise invites inclusion into the culture of ED practice. This administrative case report describes planning and early implementation of a physical therapist practice in an ED, shares preliminary outcomes, and provides suggestions for expansion and effectiveness testing of practice in this novel venue. Outcomes Referrals have increased and length of stay has decreased for patients receiving physical therapy. Preliminary surveys suggest high patient and practitioner satisfaction with physical therapy services. Outpatient physical therapy follow-up options were developed. Educating ED personnel to triage patients who show deficits in pain and functional mobility to physical therapy has challenged the usual culture of ED processes. Discussion Practice in the hospital ED enables physical therapists to fully use their knowledge, diagnostic skills, and ability to manage acute pain and musculoskeletal injury. Recommendations for future action are made to encourage more institutions across the country to incorporate physical therapy in EDs to enhance the process and outcome of nonemergent care.

scholarly journals Use of Quality Indicators in Physical Therapist Practice: An Observational Study

2012 ◽  
Vol 92 (4) ◽  
pp. 507-524 ◽  
Author(s):  
Diane U. Jette ◽  
Dianne V. Jewell
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Observational Study ◽  
Secondary Prevention ◽  
Quality Indicators ◽  
Health Care Quality ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Care Quality ◽  
Published Evidence

AbstractBackgroundThe Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 contain provisions specific to health care quality that apply to physical therapists. Published evidence examining gaps in the quality of physical therapy services is limited.ObjectiveThe primary purpose of this study was to determine the use of quality indicators in physical therapist practice.DesignThis was an observational study.MethodsAll members of the Orthopaedic and Private Practice sections of the American Physical Therapy Association were invited to participate by completing an electronic survey. The survey included 22 brief patient descriptions, each followed by questions regarding the use of examinations and interventions based on the 2009 list of Medicare-approved quality measures. Separate multivariate logistic regression models were used to determine the odds ratios related to the performance of each examination and intervention on more than 90% of patients, given perceptions of its importance to care, the burden of performing it, and the level of evidence supporting its use.ResultsParticipants (n=2,544) reported a relatively low frequency of performing examinations and interventions supporting primary and secondary prevention (3.6%–51.3%) and use of standardized measures (5.5%–35.8%). Perceptions of high importance and low burden were associated with greater odds of performing an examination or intervention. Importance and burden were more influential factors than the perceived availability of evidence to support use of identified techniques.LimitationsThe survey was not assessed for test-retest reliability. A low response rate was a source of potential bias.ConclusionThe study findings suggest that physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome.

scholarly journals Closing the Gap Between Ethics Knowledge and Practice Through Active Engagement: An Applied Model of Physical Therapy Ethics

2010 ◽  
Vol 90 (7) ◽  
pp. 1068-1078 ◽  
Author(s):  
Clare M. Delany ◽  
Ian Edwards ◽  
Gail M. Jensen ◽  
Elizabeth Skinner
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Moral Agency ◽  
Ethical Issues ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Health Care Systems ◽  
Applied Ethics ◽  
Active Engagement ◽  
Ethical Decisions

Physical therapist practice has a distinct focus that is holistic (ie, patient centered) and at the same time connected to a range of other providers within health care systems. Although there is a growing body of literature in physical therapy ethics knowledge, including clinical obligations and underlying philosophical principles, less is known about the unique ethical issues that physical therapists encounter, and how and why they make ethical decisions. As moral agents, physical therapists are required to make autonomous clinical and ethical decisions based on connections and relationships with their patients, other health care team members, and health institutions and policies. This article identifies specific ethical dimensions of physical therapist practice and highlights the development and focus of ethics knowledge in physical therapy over the last several decades. An applied ethics model, called the “active engagement model,” is proposed to integrate clinical and ethical dimensions of practice with the theoretical knowledge and literature about ethics. The active engagement model has 3 practical steps: to listen actively, to think reflexively, and to reason critically. The model focuses on the underlying skills, attitudes, and actions that are required to build a sense of moral agency and purpose within physical therapist practice and to decrease gaps between the ethical dimensions of physical therapist practice and physical therapy ethics knowledge and scholarship. A clinical case study is provided to illustrate how the ethics engagement model might be used to analyze and provide insight into the ethical dimensions of physical therapist practice.

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