Identifying and Addressing Social Determinants of Learning during the COVID-19 Pandemic

The COVID-19 pandemic has negatively impacted the health of people from communities of color and people of limited socioeconomic means in a disproportionate way due to social determinants of health (SDoH). The Centers for Disease Control defines SDoH as the “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.” A related construct, social determinants of learning (SDoL), includes contextual conditions and variables that impact students’ ability to optimally participate in their education, including academic and clinical development. SDoL directly impact students’ ability to participate in the educational process. During the COVID-19 pandemic, students struggling with SDoH and, by extension SDoL, may be more likely to have sick family members, caregiving responsibilities, food and housing insecurity, and obligations to supplement lost family wages. SDoL are also influenced by individual experiences within and outside of the classroom. Beyond bringing this matter to the attention of our profession, especially clinical and academic educators, we must take action to reach and support students who are at higher academic risk due to the SDoL. The purpose of this paper is to: (1) define SDoL, (2) explain how SDoL are impacting DPT and physical therapist assistant students, and (3) discuss actions that physical therapists and physical therapist assistants can take to mitigate the effects of SDoL on current DPT and physical therapist assistant students.

Therapy Assistant Staffing and Patient Quality Outcomes in Skilled Nursing Facilities

Therapy staffing declined in response to Medicare payment policy that removes incentives for intensive physical and occupational therapy in skilled nursing facilities, with therapy assistant staffing more impacted than therapist staffing. However, it is unknown whether therapy assistant staffing is associated with patient outcomes. Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics. Assistant staffing was not associated with functional improvement. Compared with employing no assistants, staffing 25% to 75% occupational therapy assistants and 25% to 50% physical therapist assistants were associated with more community discharges. Higher occupational therapy assistant staffing was associated with higher readmissions. Higher intensity physical therapy was associated with better quality across outcomes. Skilled nursing facilities seeking to maximize profit while maintaining quality may be successful by choosing to employ more physical therapy assistants rather than sacrificing physical therapy intensity.

Assessment of Professional Quality of Life in the Alabama Physical Therapy Workforce

Objective The purposes of this study were to: 1) determine the level of professional quality of life among physical therapists (PT) and physical therapist assistants (PTA) in Alabama and 2) to identify personal or professional factors that may contribute to compassion satisfaction (CS), burnout and secondary traumatic stress (STS). Methods This study utilized a cross-sectional design and mixed-methods survey methodology to calculate odds ratios for factors impacting professional quality of life. Respondents completed a survey that included the Professional Quality of Life (ProQOL) scale, an open-ended question regarding their experience with professional burnout, and personal and professional demographics. Results Of the 742 PTs and PTAs in Alabama that completed the survey, the majority experienced moderate-high levels of CS and moderate-low levels of burnout and STS. Regression analyses indicated clinicians working ≥40 hours per week in patient care had greater odds for low-moderate CS and moderate-high burnout and STS subscale scores. Clinicians in our sample licensed between 6–15 or > 30 years and those working in private outpatient settings had reduced odds of having moderate-high burnout while those working 16 or more years had significantly increased odds for high CS scores. Responses to the open-ended question indicated workload demands and documentation as the top factors contributing to clinician burnout, while the connections with patients and coworkers help minimize such feelings. Conclusions Individuals later in their career may develop protective factors to mitigate feelings of burnout as compared to those early in their career. Also, clinicians working 40 or more hours per week may be more vulnerable to experiencing low-moderate CS and moderate-high burnout. Thus, individual clinicians and employers must evaluate personal, occupational, and systemic factors that contribute to reduced professional quality of life to inform preventative strategies for mitigating burnout.

Exploration of Content and Reach of Physical Therapy-Related Discussion on Twitter

Background Many individuals access and share health information on social networking sites. Previous studies have analyzed the social media site Twitter to discern public opinion related to health phenomena such as antibiotics, concussions, and flu. Physical therapy-related online discussions have not been studied. Objective The aim of this study was to explore content, participants, and structure of physical therapy-related discussions on Twitter. Design This study was observational. Methods Over 12 weeks, more than 30,000 physical therapy-related tweets were collected. A random sample of 100 tweets underwent preliminary analysis to determine broad categories including tweet author, tone, and theme. A second random sample of 100 tweets was analyzed to confirm categories. Once categories were established, a new sample of 1000 tweets was randomly selected for analysis and categorization. All study investigators categorized a shared collection of tweets to establish inter- and intrarater agreement. Twitter conversations were visualized using NodeXL. Results Intrarater and interrater agreement for tweet categorization was 95% and 89%, respectively. The distribution of the intended audience was 35.5% professional, 35.5% broad reach, and 29% public. The gross distribution of tweet tone was 63.1% neutral, 31.4% positive, and 5.6% negative. Twenty-eight percent of tweets were authored by physical therapists/physical therapist assistants and nearly one-half were categorized as “marketing.” Tweets tended to be “isolated,” not within a conversation, or consist of conversation within “tight crowds.” Limitations This study was purely observational. Social media content can be highly influenced by temporal events, which limits the generalization of specific findings. Conclusions Study results indicate that the reach of physical therapy-related tweets may not be as broad as intended by the author. Physical therapy professionals and the hospitals/clinics that employ them may need to implement strategies to be more intentional in reaching a broader audience with online messages.

A Multidimensional Exercise Program in the Home for Older Adults Designed to Improve Function

The purpose of this study was to determine whether there was difference in the OASIS (Outcome and Assessment Information Set) activities of daily living (ADL) items scores between the Safe Strides program and Safe Strides plus Zōntago program. Eight home care offices were selected for this prospective randomized quality improvement study where Safe Strides versus Safe Strides plus Zōntago were compared. Rehabilitation outcome OASIS ADL change scores were analyzed for 112 total patient care episodes. The Safe Strides + Zōntago mean total ADL score change and ADL change per visit were higher than the Safe Strides group. Differences in ADL outcomes in older adults undergoing home care provided by physical therapists and physical therapist assistants in the Safe Strides exercise program versus the Safe Strides plus Zōntago program were noted. The Safe Strides + Zōntago compared with Safe Strides alone improved patient functional outcomes as measured by the OASIS.

The Revised APTA Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant: Theory, Purpose, Process, and Significance

IntroductionIn June 2009, the House of Delegates (HOD) of the American Physical Therapy Association (APTA) passed a major revision of the APTA Code of Ethics for physical therapists and the Standards of Ethical Conduct for the Physical Therapist Assistant. The revised documents will be effective July 1, 2010.PurposeThe purposes of this article are: (1) to provide a historical, professional, and theoretical context for this important revision; (2) to describe the 4-year revision process; (3) to examine major features of the documents; and (4) to discuss the significance of the revisions from the perspective of the maturation of physical therapy as a doctoring profession.Process of RevisionThe process for revision is delineated within the context of history and the Bylaws of APTA.Format, Structure, and Content of Revised Core Ethics DocumentsThe revised documents represent a significant change in format, level of detail, and scope of application. Previous APTA Codes of Ethics and Standards of Ethical Conduct for the Physical Therapist Assistant have delineated very broad general principles, with specific obligations spelled out in the Ethics and Judicial Committee's Guide for Professional Conduct and Guide for Conduct of the Physical Therapist Assistant. In contrast to the current documents, the revised documents address all 5 roles of the physical therapist, delineate ethical obligations in organizational and business contexts, and align with the tenets of Vision 2020.SignificanceThe significance of this revision is discussed within historical parameters, the implications for physical therapists and physical therapist assistants, the maturation of the profession, societal accountability and moral community, potential regulatory implications, and the inclusive and deliberative process of moral dialogue by which changes were developed, revised, and approved.

Do As I Do: Exercise Habits of Physical Therapists, Physical Therapist Assistants, and Student Physical Therapists

BackgroundPhysical therapy practitioners are among the many health care professionals who can counsel their patients to address the public health care concern of physical inactivity. Health care providers who are physically active themselves are more likely to counsel patients on the benefits of activity.ObjectiveThe purposes of this study were: (1) to examine the leisure-time physical activity habits of physical therapists, physical therapist assistants, and student physical therapists in the United States using Centers for Disease Control and Prevention and American College of Sports Medicine (CDC-ACSM) recommendations and (2) to compare these habits with those of the general population and other health care professionals.DesignA cross-sectional survey design was used.MethodsThere were 2 data sources. A random sample of American Physical Therapy Association members completed an online survey that included questions about physical activity habits worded in same manner as the leisure-time activities section of the 2005 National Health Interview Survey (NHIS). The final study sample comprised 1,238 participants: 923 physical therapists, 210 student physical therapists, and 105 physical therapist assistants. The 2005 NHIS public use data files were the source for the same information about the general US population and for a subset of health care professionals. Rates of participation in vigorous and moderate physical activity were analyzed.ResultsPhysical therapists, physical therapist assistants, and student physical therapists exercised at higher rates than adults and health-diagnosing professionals in the 2005 NHIS.LimitationsThe study may be limited by sampling and response bias.ConclusionsThis study identified that physical therapists, physical therapist assistants, and student physical therapists are meeting CDC-ACSM physical activity guidelines at higher rates than the US adult population and health-diagnosing professionals. These rates exceed the physical activity targets set for adults in Healthy People 2010.