2313 research outputs found
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Dry Needling Curricula in Entry-Level Education Programs in the United States for Physical Therapists
No full textObjectives: The objective of this paper was to determine the extent to which dry needling is instructed in entry-level education programs for physical therapists.
Methods: Program directors from 226 entry-level education programs recognized by the Commission on Accreditation in Physical Therapy Education were recruited via e-mail to participate in an anonymous 35-item electronic survey during the 2017-2018 academic year. The survey evaluated dry needling curricula, faculty qualifications, attitudes and experience, and programs\u27 future plans for teaching dry needling.
Results: A total of 75 programs responded to the survey (response rate = 33.1%). Forty (53.3%) had integrated dry needling theory and psychomotor training into their programs and 8 (10.6%) planned to include such content in their curriculum in the future. Of the 40 respondents, 28 indicated that dry needling education was integrated into a required course, 4 indicated that dry needling was an elective course, and 8 did not specify how dry needling education was integrated. Faculty teaching dry needling appear to be well qualified, with the majority having 5-10 years of experience using dry needling in clinical practice. The primary reason for programs not teaching dry needling is that it was not considered an entry-level skill.
Discussion: There appeared to be variability in how dry needling was integrated into the curricula, as well as in the depth and breadth of instruction. Our research may serve as a baseline for faculty to assess existing dry needling curricula and as a guide for developing curricula in new or existing physical therapy programs
Survey of Physical Therapists’ Knowledge of Screening and Management Practices for Patients with Prediabetes
No full textPURPOSE: It is estimated that up to 80% of patients referred to outpatient physical therapy have diabetes, prediabetes, or diabetes risk factors; thus, physical therapists are in an optimal position to intervene as members of a multidisciplinary team working to effectively manage and reduce the diabetes epidemic. The purpose of this study is to assess the knowledge, practices, attitudes and beliefs of private practice physical therapists toward patients with prediabetes. METHODS: One thousand members of the Private Practice section of the American Physical Therapy Association were randomly selected through a random number generator to participate. Participants completed a paper based survey that was specifically designed for this study. RESULTS: Sixty-three physical therapists (34 males, 29 females; mean age: 52.8±11.5 years; mean number of years of clinical practice: 25.7±12.3 years) agreed to participate. The majority of participants (79%) agreed that identifying prediabetes in their patients is important; only 3% identified all of the risk factors that should prompt prediabetes screening. Seventy three percent of participants identified the correct laboratory test to screen for diabetes;\u3c10% could identify the correct laboratory parameters for diagnosing prediabetes and diabetes. Only 2% and 22% of participants could identify correct weight loss and physical activity recommendations, respectively. CONCLUSION: A number of gaps in the knowledge of private practice physical therapists were noted in this study. These results may have important implications for the education of private practice physical therapists, especially those providing care for patients without a referral who are at risk for diabetes
An Evidence Based Proposal Supporting the Implementation of a Nurse Practitioner Liaison Program Within the Transition to Palliative Care
No full textClinical Problem: It is universally known that there are many barriers hindering a smooth transition to palliative care services. One main barrier of transitioning from acute care to palliative care is lack of continuity of care. Factors that are lacking to sustain continuity include time pressure, limited resources, and increased demands for economic rationality. Factors that aided in the continuity of care are the hiring of extra personnel, advanced care planning, and increasing the competence of permanent employees (Midtbust et al., 2018).
Significance: This clinical problem poses significance because healthcare professionals experience many structural barriers which complicate the advancement of palliative care. This leads to uncontrolled symptom management, increased financial hospital expenses due to frequent admissions, poor goal attainment, patient and family dissatisfaction with the health care system and team, and patients feeling a lack of support from the healthcare team.
PICOT Question: This evidence-based proposal looks to answer the question of, “Among patients with incurable diseases of cancer, chronic obstructive pulmonary disease or congestive heart failure who are transitioning to palliative care, does implementation of a nurse practitioner liaison program 1) improve patient satisfaction with the transition of palliative care, 2) reduce hospital readmissions and 3) improve symptom management for pain control, respiratory distress and intractable nausea over six months?”.
Clinical Change: The clinical change proposed is to implement a nurse practitioner led liaison program to maintain continuity of care from the primary care setting into the palliative care setting.
Desired Outcome: The desired outcomes are an increase in patient satisfaction survey scores with the nurse practitioner liaison program and a noted decrease in hospital admissions post program implementation for symptom management such as pain control, respiratory distress, and intractable nausea.
Summary: After reviewing the literature it is concluded that lack of continuity of care was a large contributing barrier for patients when transitioning to palliative care. This evidence-based proposal demonstrates a plan for implementation of a nurse practitioner liaison program which can be adapted in multiple acute care settings. It is important to try to minimize complications associated with lack of continuity of care by implementing a nurse practitioner liaison program. The nurse practitioner liaison program aims to increase communication, meet the individual complex needs of the patients, increase satisfaction within the palliative care program, educate family members, reduce hospital admissions, and manage symptoms associated with chronic illnesses
Emerging Perspectives of Virtual Reality Techniques
No full textOver the past several years, innovations in technology have progressively challenged traditional rehabilitation paradigms. More specifically, virtual reality (VR), often in combination with robotic devices, continues to emerge as an option to assist, augment, evaluate, and document the rehabilitation for individuals with a variety of neurologic disorders. The most promising VR rehabilitation approaches are task-oriented, based on contemporary concepts of motor learning and practice-induced neuroplasticity designed to improve motor function including balance, gait, and activities of daily living. The purpose of this chapter is to review relevant evidence on neuroplasticity and describe VR rehabilitation applications (including VR-augmented robotic devices) targeting motor function in persons with neurologic and orthopedic disorders. An overview of VR neurorehabilitation, extensively studied in individuals with stroke, Parkinson\u27s disease, and cerebral palsy, will be described as a viable option for the rehabilitation of patients with neurological disorders. Additionally, a review of recent clinical trials begins to demonstrate the effectiveness of VR in the orthopedic rehabilitation setting, as well as in the role of decreasing and managing pain in individuals either undergoing medical procedures or dealing with chronic pain. Finally, we describe the application of a commercially available VR-enhanced haptic robotic device using a task-oriented rehabilitation approach for a patient with an orthopedic disorder of the wrist and hand to improve functional outcomes. The feasibility of this approach, as well as the acceptance of the device and training program, is discussed
Use of a Quality Improvement Initiative to Improve Healthcare in Primary Care for LGBTQ Individuals
No full textClinical Problem: The clinical problem that this paper will address are the health disparities and lack of appropriate care received for LGBTQ patients. Research studies show that LGBTQ patients are more likely to experience certain illnesses and diseases such as STDs and also participate in higher-risk activities as compared to their heterosexual and cisgender counterparts.
Significance: This clinical problem is significant because without intervention inappropriate care and health disparities will continue for LGBTQ patients, which account for approximately 4.5% of the population in the U.S (The Williams Institute, 2019). If no action is taken, LGBTQ patients may continue to experience discrimination and lack of appropriate screening and testing.
PICOT Question: Among the LGBTQ+ population in a primary care office, what is the impact of implementing a Practice Improvement Collaborative and Project Extension for Community Health Outcomes (ECHO) on (1) inclusion and safety (2) SOGI collection and reporting (3) riskbased sexual history taking and (4) appropriate STD and HIV screening?
Clinical Change: The clinical change is to implement a Project ECHO and a Practice Improvement Collaborative. A Project ECHO is a video-conferencing educational system for providers to meet with providers that specialize in the care of LGBTQ patients to gain knowledge and training to provide appropriate care for LGBTQ patients. A Practice Improvement Collaborative is an internal system that includes a quality improvement team that includes teaching through interdisciplinary collaboration and motivates and educates their respective teams.
Desired Outcome: After implementation of the clinical change, we hoped that there would be improvements in inclusiveness and safety of the LGBTQ patients, improved SOGI documentation, improved risk-based sexual history taking, and improved STD and HIV risk-based screening.
Summary: In summary, research suggests that implementation of a Project ECHO and a Practice Improvement Collaborative would be beneficial to improve care for LGBTQ patients in a primary care office. This paper will also discuss the plan for implementation of the evidence-based practice proposal into a primary care office
The Use of a Direction Tolerance System for Patients with Low Back Pain: Intra-Rater Reliability and Outcome
No full textBackground and Purpose: In recent years, the approach to treating patients with low back pain (LBP) has evolved to establishing patient diagnosis based upon common clinical characteristics. Several classification systems exist in the current literature; however, the current systems lack examination of tolerance to movement exclusively in the standing position. The Direction Tolerance System (DTS) provides the clinician an examination and treatment tool that observes patient movement through all planes of motion in standing. The purpose of this study was to evaluate the intra-rater reliability of the DTS assessment in patients with LBP, investigate patient success outcomes using the DTS treatment protocol, and determine if an association exists between patient clinical characteristics and outcomes achieved using the DTS. Methods: Five physical therapists (2-26 years of experience) performed the testing and treatment in the study. Sixty subjects, ages 18-80 years (mean = 52 ± 16.0), with LBP were examined and treated using the DTS protocol. The Direction Tolerance Index (DTI), Numeric Pain Rating Scale (NPRS), Oswestry Disability Questionnaire (ODQ), and Fear-Avoidance Beliefs Questionnaire - Physical Activity Sub-scale (FABQ-PA) were collected for inclusion criteria and to evaluate outcomes. Findings: Intra-rater ICC was 0.80 (95% Confidence Interval 0.68-0.88) indicating good reliability (p\u3c0.001). Of the 60 subjects that completed the study, 75% achieved a positive outcome with 62% (37/60) classified as success and 13% (8/60) classified as improved. Clinical Relevance: As treatment classification systems become more prominent in clinical use, the DTS may provide clinicians across all levels of experience a reliable tool that requires minimal training and is easy to administer a way to successfully examine and treat patients with LBP. Conclusion: The results of this study preliminarily suggest that the DTS is a reliable and effective tool for the examination and treatment of patients with LBP using functional testing and treatment positions
The Sept. 11 Attacks\u27 Effects on Government Administration: Public Administration Experts Join the Podcast to Discuss How The Events Of 9/11 Have Changed The Administrative State [Podcast Episode]
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Lessons Learned for Improving Educational Technology Adoption During Volatile, Uncertain, Complex, and Ambiguous Situations
No full textThis case study explores how educational technology adoption during an emergency shift to remote teaching due to the COVID-19 pandemic, links to the Technology Acceptance Model (TAM) and the Substitution Augmentation Modification Redefinition (SAMR) model. Faculty from two distinct departments of a small four-year private college described their educational technology adoption. Results indicated that urgency and a desire to serve students led the way for technology adoption. The college, colleagues, and students were the technology influencers. Zoom and Blackboard (Bb) were the most prevalent educational technologies used during the shift to remote teaching