Care, Consent, and Compromise: An Ethical Cartography of Physical Therapy Practice in the Global South

emphasis of this special issue is on the history of physical therapist education; one manuscript, however, specifically illustrates the history of physical therapist assistant education. All of the authors describe the early days of physical therapy in the United and the external and internal influences that make physical therapist practice and education what it is today. As you read this issue, you will be impressed by the way societal and political factors, along with the continual evolution of disease, have affected physical therapist practice. Over the years, the manner in which physical therapy professionals dress, talk, and relate to patients has changed markedly. Surges or resurgences of certain diseases have impacted the profession, as has the political arena, from payment structures to the domination by physicians of our profession in the early days. key elements of our profession include practice, teaching, and research. transformations in physical therapy education and practice were very difficult to capture in short manuscripts. authors have provided you with a tour of critical past events. Physical therapy practice has evolved from being prescriptive, with physicians telling physical therapists exactly what to do, to physical therapists practicing independently. proposed national Medicare regulations for payment for direct-access services substantiates how far this profession has come; this issue is discussed by Marilyn Moffat, PT, PhD, CSCS, FAPTA, in The History of Physical Therapy Practice in the United States and by John L Echternach, PT, RdD, HCS, FAITA, in his article The Political and Social Issues That Have Shaped Physical Therapy Education over the Decades. Education has also changed from being prescriptive to evidence-based over the last 80 years, as illustrated by Elizabeth H Littell, PT, PhD, and Geneva Richard Johnson, PT, PhD, FAPTA, in their article Professional Entry Education in Physical Therapy during the 20th Century. At one time, when a teacher entered the room all of the students had to stand up in deference to the instructor. Those days are long gone! Students now expect excellence and challenge their instructors, which would not have been accepted in the early days of physical therapy education. Clinical instruction has also changed with the evolution of the profession. With entry-level doctoral education, identifying and developing superb clinical instructors (CIs) is a challenge. Issues such as finding talented CIs to mentor students continue to be a concern, as does the number of clinical placement sites. Jan Gwyer, PT, PhD, and colleagues, in The History of Clinical Education in Physical Therapy in the United States, describe critical issues that have shaped clinical education. evolution of the Doctorate in Physical Therapy (DPT) has recently been a catalyst for change in the profession. Schools across the county have followed the Creighton University faculty in offering a DPT degree. Creighton University faculty's decision to train doctorally prepared clinicians was controversial, widely discussed, and criticized. They believed in their goal and persevered. Sidney J Stohs, PhD, FASAHP, FACN, CNS, FATS, and colleagues explain the steps in the evolution of the first physical therapist doctoral program in their paper, Initiating Clinical Doctoral Education in Physical Therapy: case of Creighton University. …

Purpose: Mounting evidence supports the use of cognitive and behavioral techniques as part of physical therapist practice. These methods are used within a physical therapist’s multimodal treatment approach for the management of pain and to facilitate health behavior change. There is a multitude of evidence-based cognitive behavioral techniques to choose from including newer approaches based on Acceptance and Commitment Therapy. Yet few studies have examined physical therapists’ perceptions to learning and implementing ACT into clinical practice. The purpose of this manuscript is to present a clinical perspective of physical therapists learning about and incorporating Acceptance and Commitment Therapy in clinical practice. Methods: An 8-week online physical therapist-led ACT for chronic pain training was completed by 65 physical therapists. A post-training evaluation was developed and then scored by 46 participants. The evaluation included 15-questions with regard to the self-reported perceptions of learning foundational ACT skills necessary to implement into physical therapy practice, a deeper understanding of psychological factors involved in musculoskeletal pain, confidence in managing musculoskeletal pain, utility in physical therapist practice, and the recognition of a new or different approach to treating musculoskeletal pain. Results: Participants’ self-reported perceptions were highly positive with 73% reporting the training furthered their understanding of psychological factors in chronic musculoskeletal pain and 100% reported learning the foundational ACT skills necessary to implement it into physical therapy practice. In addition, 7 sub-themes regarding the ACT training emerged from a qualitative content analysis and included the following: 1) The training filled a knowledge gap in understanding of how to assess and treat psychological factors related to pain, 2) A mixture of prerecorded video training, reading, experiential exercises, and self-reflection via the ACTPTE were critical to reinforce learning, 3) Coaching and supervision calls were a useful part of the training and helped to translate course knowledge and implement into clinical practice, 4) Having an opportunity to practice in a group setting with like-minded peers was a critical component of confidence building, 5) Ongoing communication, networking, and mentorship via the online forum and coaching calls allowed participants to complete the course material on-time, stay connected, and share stories and experiences about implementing the material in practice, 6) The ACT stance of not changing pain or related psychological content (example: not changing thoughts, pain related beliefs, reconceptualizing pain) may run counter to other psychologically-informed approaches found in physical therapy practice and took some time for practitioners to process and integrate, 7) Some practitioners expressed that ACT helped them cope with work-related stress and burnout and to drop the struggle of fixing or curing every patient with pain. Conclusions: ACT delivered via an online training was acceptable to physical therapists and supervision calls were necessary for confidence building and implementation into practice. The ACT model was perceived as adaptable to the practice of physical therapy as well as the complex clinical and psychosocial presentation of many chronic pain conditions. Future investigations should explore brief training interventions, treatment fidelity, long-term outcomes, the development and validation of a scale to measure knowledge, concepts and skills conceptualizing psychological flexibility within physical therapist practice.

Development of a Statement on Autonomous Practice

This article explores the common factors model of psychotherapeutic intervention and discusses its relevance for physical therapy practice. The model provides an explanation for why the effects associated with specific technical approaches only minimally explain successful psychotherapy clinical outcomes. It postulates that factors common across diverse interventions (i.e. 'nonspecific' mechanisms) are responsible for a larger component of treatment efficacy. We outline the applicability of the common factors model to physical therapy and provide supportive evidence from evaluation and prognostic research on interventions for conditions seen in musculoskeletal physical therapy practice. The relevancy and consequences of applying the common factors model to physical therapy practice and research are discussed. The continued advance and evolution of the physical therapy profession requires creative and comprehensive analysis of all factors impacting clinical effectiveness. Additional research is needed to more clearly delineate the common factors that are operational in physical therapy practice and to measure their relative impact on clinical outcomes.

Discordance Between Cardiopulmonary Physiology and Physical Therapy

The purpose of this qualitative study was to identify the dimensions of clinical expertise in physical therapy practice across 4 clinical specialty areas: geriatrics, neurology, orthopedics, and pediatrics. Subjects were 12 peer-designated expert physical therapists nominated by the leaders of the American Physical Therapy Association sections for geriatrics, neurology, orthopedics, and pediatrics. Guided by a grounded theory approach, a multiple case study research design was used with each of the 4 investigators studying 3 therapists working in one clinical area. Data were obtained through nonparticipant observation, interviews, review of documents, and analysis of structured tasks. Videotapes made during selected therapist-patient treatment sessions were used as a stimulus for the expert therapist interviews. Data were transcribed, coded, and analyzed through the development of 12 case reports and 4 composite case studies, one for each specialty area. A theoretical model of expert practice in physical therapy was developed that included 4 dimensions: (1) a dynamic, multidimensional knowledge base that is patient-centered and evolves through therapist reflection, (2) a clinical reasoning process that is embedded in a collaborative, problem-solving venture with the patient, (3) a central focus on movement assessment linked to patient function, and (4) consistent virtues seen in caring and commitment to patients. These findings build on previous research in physical therapy on expertise. The dimensions of expert practice in physical therapy have implications for physical therapy practice, education, and continued research.

Introduction. The purpose of this study was to evaluate the utilization of spinal thrust manipulation in the management of patients with low back pain (LBP) among physical therapists from New York State (NYS), as well as to evaluate physical therapist knowledge of a lumbar spine manipulation clinical prediction rule (CPR) and whether their NYS physical therapy practice act allows for spinal thrust manipulation to be performed. Materials and Methods. We invited the 300 physical therapy clinics from NYS who serve as clinical instruction sites for the Department of Physical Therapy at Daemen College in Amherst, NY, to participate in this survey-based study. One hundred fifty physical therapists completed the survey and were included in the analysis (54% were female and 45.3% were male; 1 respondent did not answer); the mean number of years of physical therapy practice of the participants was 13.3 ± 9.9 years (range, 1–44 years). Participants were invited to complete a survey that was comprised of questions relative to demographics, the use of thrust manipulation in the treatment of patients with LBP, their knowledge of a manipulation CPR, and the NYS physical therapy practice act and its ability to allow physical therapists to perform thrust manipulation. Chi-square tests, 1-way analyses of variance, and t tests were used for analyses. Results. Of the sample population, 41.3% reported performing spinal thrust manipulation, and the majority of those physical therapists (77.4%) use the intervention between 0% and 25% of the time. Thirty-seven percent of clinicians who reported manipulating patients with LBP reported using a CPR to determine candidates for manipulation; the remainder of the respondents (63%) did not provide an answer or were unsure. Of the sample population, 63.9% correctly answered the survey question regarding the NYS physical therapy practice act and an ability to legally perform thrust manipulation. Physical therapists who are board certified in orthopedics through the American Physical Therapist Association (P = .005) or residency/fellowship trained in manual physical therapy (P = .03) are significantly more likely to perform thrust manipulation than those who are not. Physical therapists who understand the NYS physical therapy practice act (P = .014), attend continuing education regarding the management of patients with LBP (P = .007), and are male (P < .00001) are also significantly more likely to perform thrust manipulation for patients with LBP. Conclusions. Despite emerging evidence to support the use of thrust manipulation in the management of patients with LBP, utilization of thrust manipulation among physical therapists still remains relatively low. Physical therapists who are board certified in orthopedics and/or residency/fellowship trained, attend continuing education, and better understand the NYS physical therapy practice act are more likely to perform thrust manipulation. The results of this study may have implications for professional development and educational efforts regarding the training of physical therapists in the utilization of thrust manipulation.

Background and Purpose. Health care professionals (HCPs) in the United States are beginning to realize that they work in a multicultural, multiethnic, and culturally diverse society. Prior research has shown that limited or lack of cultural adaptability and cultural competence by HCPs is potentially dangerous to patient care and treatment outcomes. Prior to studying the cultural adaptability of physical therapist (PT) students, the reliability of using cross-cultural instruments needs to be established. The purpose of this study was to establish the reliability of using the Cross Cultural Adaptability Inventory (CCAI) with PT students. Subjects. The sample consisted of 288 entry-level master's degree PT students. Methods. The CCAI, a 50-item instrument that measures the construct of cultural adaptability on 4 dimensions (emotional resilience, flexibility/openness, perceptual acuity, and personal autonomy) was administered during the fall academic semester. Results. Data were analyzed and the reliability was estimated using the Cronbach alpha coefficient of internal consistency. The total score had an estimated reliability of .90. Discussion and Conclusion. The data supported the hypothesis that the CCAI is a reliable instrument for use with PT students. Further research could explore the cross-cultural adaptability levels of faculty, students, and clinical practitioners.

INTRODUCTION Dr Geneva R. Johnson (Figure 1) continues to influence physical therapy education as an inspirational participant in the Third Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum (GRJ Forum). Dr Johnson is recognized for her longstanding leadership and mentorship, having contributed to the advancement of physical therapy education, practice, and research for over 60 years. The GRJ Forum started in 2014 through the collaborative efforts of the Academic Council of Academic Physical Therapy (ACAPT) and the Physical Therapy Learning Institute (PTLI).3,12 Once again it was the keynote for the 2016 Education Leadership Conference (ELC) held in Phoenix, Arizona. As expected, the Forum continues to foster creative ideas for positive change to promote excellence in physical therapist education, a hallmark of Dr Johnson's legacy. As in previous years, the Forum set the stage for energy, enthusiasm, and excitement for conference participants as discussions evolved to explore new opportunities to promote excellence in education. The GRJ Forum design is like no other in our profession. Key to its success is provocative speakers who share personal perspectives, immediately followed by active engagement all participants. As Tschoepe shared in her recognition to Dr Johnson and the introduction of the Forum, many remember what has become known as “Dr Johnson's 3 Ps of strong leadership skills”: passion, persistence, and perseverance. Illustrations of these, as well as other essential personal leadership skills, were explored throughout the Forum by many speakers at ELC 2016.FigureGeneva R. Johnson, PT, DPT, PhD, FAPTA, is a national leader in physical therapy education through her search of excellence in patient care, clinical research, clinical specialization, administration, staff development, and postgraduate education. Her main contribution to the advancement of the profession certainly was “to expect physical therapists to be responsible for their actions, to care about themselves and each other, to value their contributions to patient care, and to create their own futures.”1 She envisioned limitless possibilities for the profession and shared that vision with others. Dr Johnson's leadership has been acknowledged over the years by the American Physical Therapy Association (APTA) Mary McMillan Lecture Award and Catherine Worthingham Fellow (1985), the APTA Lucy Blair Service Award (1988), the Army Physical Therapy Program Outstanding Alumni Award (1994,) and the APTA Pauline Cerasoli Education Award (2008). Most recently, her legacy was recognized by the American Council for Academic Physical Therapy (ACAPT), who established the Geneva R. Johnson Annual Forum on Innovation in Physical Therapy Education. 1. Johnson GR. Great Expectations: A Force in Growth and Change. Phys Ther. 1985;65:1690–1695. THE GRJ FORUM: ORGANIZATION AND STRUCTURE The GRJ Forum is designed to: Create a safe environment for key stakeholders in physical therapy education to discuss the infinite possibilities of the future, rather than solving problems of the past. Encourage vision, innovation, creativity, and provocative new ideas that can positively influence the future of physical therapy education. Challenge educators to proactively advance physical therapy education to prepare graduates to meet projected societal and professional needs rather than merely react to external pressures.3 The 2016 GRJ Forum featured Dr Emma Stokes, an international visionary leader and current World Confederation for Physical Therapy (WCPT) president, who energized the over-800 conference participants and set the stage for ongoing conversation and idea development throughout the conference. Her keynote was followed by 3 Ignite Talks from active leaders in physical therapy education in the United States - Dr Michael Majsak, Dr Bob Rowe, and Dr Chris Sebelski. Collectively, they shared individual perspectives of what each believed to be critical to foster graduate success in physical therapist practice that is entrepreneurial in spirit, illustrates personal ownership and accountability, and offers a unique value to the health care team to facilitate optimal, efficient, and effective individual-centered health promotion and management. Discussion by over 200 participants followed these speakers, and they more thoroughly explored the 13 themes presented, and discussed “how might we” or “wouldn't it be great if…” Participants had options to discuss 2 different themes, and table facilitators shared 3 possible highlights that might illustrate innovation and educational change to include education that really matters to better prepare physical therapist graduates for success in their future professional careers THIRD ANNUAL GRJ FORUM HIGHLIGHTS Keynote Address - Walk With the Dreamers Emma Stokes, PT, PhD, is deputy head of the Department of Physiotherapy and a fellow of Trinity College in Dublin, Ireland. She teaches in the university's entry to practice and PhD programs in Dublin and Singapore. Her research focuses on matters related to professional practice; particularly, leadership in the profession. She has received numerous awards and professional recognitions for her contributions to the physiotherapy profession and has been a board member of the World Confederation for Physical Therapy (WCPT) since 2007. She was elected as the president of WCPT in 2015. Dr Stokes opened her inspirational keynote with a quote from John F. Kennedy: “Let us think of education as the means of developing our greatest abilities, because in each one of us there is a private hope and dream, which if fulfilled can be translated into benefit for everyone.” Stokes brought us on a journey, as an outside international colleague looking in, that examined whether the introduction of the DPT fulfilled its desired intentions; whether, in its current design, it meets the needs and ambitions of the profession, and whether it facilitates leadership skills needed for our graduates to be able to respond to, shape, and serve the future health needs of society. Stokes challenged all participants to reconsider curricular priorities and improve balance in our DPT education programs. Stokes reminded us of the original intentions of the move to the DPT as part of Vision 2020. Rothstein11 stated that the move to postbaccalaureate education was “based on a moral authority derived from educational need and the expectation that a profession serves society before itself,” and the “need to prepare physical therapists to exemplify the highest standards of health care, use evidence, skillfully apply techniques, be thoughtful and effective…within the confines of a healthcare system that can promise nothing but chaos for the foreseeable future.” Her review of the stated aims and key expected outcomes of Vision 2020 led her assessment to confirm that not all of the anticipated outcomes have been realized. For example, she noted the matter of reimbursement, fully implemented and available direct access, and the balance of clinical content with leadership and advocacy within DPT curriculum are not yet fully appreciated. While there is a move in countries such as Pakistan, Iran, and Taiwan to move to entrylevel DPT, as well as discourse in Canada and Australia9 suggesting such a need, the global physical therapy community has not followed suit and the baccalaureate degree remains the most common entry-level qualification. Moreover, the country with unquestionably the largest scope of practice in physical therapy—the United Kingdom—achieves this with an entry-level education requirement of a bachelor's degree. She stated unequivocally that the current DPT education was shying away from what is critically needed to develop the next generation of leaders to be equipped to advocate and lead the transformative change articulated in the ambitious plan of the American Physical Therapy Association (APTA) and to respond to the health challenges facing our communities, now and in the future. What does the next generation of DPT leaders need to lead the transformation required? Leadership development cannot be a “footnote” in our core values and in our curricula. Drawing on a conversation with Orla Tinsley, a young woman living with cystic fibrosis (CF) and a passionate advocate for people with CF, she recounted Orla's message to participants: “Sometimes in science it can be hard to reach for the marvelous. We are taught that science is a place of precision and parameters when really these are the elements we need to step into the space of the marvelous. Once we know the rules, we must not be afraid to push forward and learn how to bend and even break them in ways that can be calculated and revelatory.” Stokes asked us to reflect and be sure we have a place for both the marvelous and the matter of fact in our DPT curricula. In other words, have we enough space within a curriculum to teach the next generation of leaders the skills and knowledge they need for successful advocacy and leadership? Her view at current continues to be a resounding “no.” Stokes shared that transformative leadership requires new rules, new ways of acting, and new perspectives. It requires that we consider design not only function; story not only argument; symphony not only focus; empathy not only logic; play not only seriousness; and meaning not only accumulation.10 It will require physical therapists who understand themselves, others, and organizational dynamics, and who have the skills, capacity, and willingness to lead.4 Are we shying away? Stokes maintained the answer is yes, we are shying away from providing leadership and advocacy skills in our entry-level education. She cited the Commission on Accreditation in Physical Therapy Education's standards for professional entrylevel education, and noted that unfortunately, leadership is cited only 4 times, and on 3 occasions, it related to the faculty. If this is the behavior we want from graduates, then where is the emphasis on leadership and advocacy in these standards? She encouraged us to consider how might we create a greater urgency of the importance of curricular balance at the accreditation, program, and faculty intention levels. Stokes continued by considering the Delors et al5 report for UNESCO on education—“Learning, the treasure within”—and contends that in our entry-level programs, we teach “learning to know, and learning to do” well. However, she is not convinced that we place sufficient time and emphasis on “learning to live together and learning to be,” key aspects of personal leadership development. At the WCPT Futures Forum, Sefan Jutterdal,8 president of the Swedish Physiotherapy Association, called upon the global physiotherapy community to be more like Pippi Longstocking - responsible, courageous, and imaginative. Stokes asked participants to identify and ensure we build into curricula the responsibility to be courageous and transformative. She closed her keynote with some difficult yet insightful questions for the group: Do we reward behaviors we want? If we want the next generation to be leaders, to be advocates, to be transformative, do we reward these behaviors in the same way that we reward clinical skill performance? Do we clearly define and measure our leadership and advocacy deliverables? Do the organizations that evaluate how well we, as academic programs, achieve our educational outcomes, evaluate, and reward inclusion of leadership and advocacy learning experiences? In closing, she wished the group, “for today, for tomorrow, for the rest of the time that we teach and learn and research and educate the next generation of leaders, to ‘walk on air, against your better judgment.’7 Only in this way is it possible to teach what really matters to our future graduates!” IGNITE TALKS The IGNITE speakers had 5 minutes to share their personal perspectives to the Forum question or to offer a response to the key points of Dr Stokes’ keynote address. Each was encouraged to challenge the status quo, share new ideas and approaches, or raise emotional levels of conference participants in a manner to foster evaluation and action of new practices in physical therapy education. First Ignite Talk - Curious: What Does It Take to Believe and Act? Dr Chris Sebelski, PT, DPT, PhD, OCS, associate professor at Saint Louis University, director of the SLU-SSM Physical Therapy Orthopedic Residency Program, and a fellow of the Education Leadership Institute (ELI), offered her IGNITE TALK from a faculty and residency director perspective. She asked, why are physical therapists perceived to be better advocates for their patients than for themselves and the profession? Also, why are physical therapists comfortable with being quietly competent when the profession is in need of a unifying vision and an identifiable, marketable skill that secures a position as a provider and expert of the movement system and movement dysfunction? To answer these questions, she examined self-efficacy and actions of physical therapists in today's practice environments. Sebelski referenced Bandura,1 who describes self-efficacy as the personal judgment or conviction that one can successfully execute the behavior(s) required or execute a desired course of action to produce certain outcomes. In her recent research, over 600 therapists responded to a request to complete a standardized tool on leader self-efficacy. Through a series of questions, an aggregate score was used to determine an overall rating of perceived self-efficacy in leadership. Physical therapists in her study reported moderate to strong beliefs that they have the skills and behaviors to lead. Although the therapists in the study had moderate to strong self-efficacy leader beliefs, those therapists over 40 years of age had greater beliefs that they knew how to coach and how to inspire others, behaviors recognized by several authors to be critical in personal leadership development. These findings lead her and others to explore explicit directions to encourage attainment of positional leadership by those in our profession. Therapists need to develop skills to coach and inspire not only their patients but each other. Seasoned therapists need to live the performance accomplishments of a leader, thus giving the more novice physical therapists role models, examples, and vicarious opportunities necessary to further develop personal leadership skills early in their professional careers. Younger therapists need to be more consistently exposed to a lens where leadership skills beyond the individual patient interaction is explicitly discussed and expected. Leadership training should be intentionally addressed within curricula at entry-level, residency, and fellowship programs. She encouraged harnessing these beliefs of leader self-efficacy into the attainment of explicit leadership skills and the commitment to act in a manner that will advance our profession. Sebelski ended her IGNITE within the spirt of appreciative inquiry: “What would happen if since we strongly believe that we can lead that we actually feel empowered to act and lead?” Second Ignite Talk - Do Great Students Make Great Physical Therapists? Dr Bob Rowe is the executive director of Brooks Institute of Higher Learning (Brooks IHL) within the Brooks Health System, located in Jacksonville, Florida. Currently, he serves as a director on the APTA Board of Directors, and is the immediate past president of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Bob shared his IGNITE from a clinical practice and residency perspective. He pointed to a lack of passion demonstrated by the majority of physical therapists in today's practice environments, as evidenced by the intent “to do nothing beyond the minimum requirements of employment and licensure,” a challenge in our profession. He encouraged the academic community to develop admission criteria that consider passion and to design intentional efforts to develop passion in thoughtful learning experiences within DPT professional entry and postprofessional residency education. Rowe challenged participants to consider the types of students accepted into DPT education programs. He confirmed that we recruit academically superior students who graduate and pass the national licensure exam. Yet, only 30% of physical therapist licensees in the United States are APTA members and only 10% of these members contribute to the APTA Political Action Committee (PAC). Rowe posed 4 reflective questions: How many physical therapists show up to their employment site at the designated time and then leave at the designated end of the day? How much time do physical therapists spend in daily reflection on their patient's needs and progress or their own professional development? How many physical therapists are committed to being actual lifelong learners versus merely meeting the minimum state requirements for continuing education for licensure? How many physical therapists have ever attended a legislative advocacy hearing, or visited their state legislator or member of Congress to advocate for the profession? Rowe acknowledged that physical therapists often provide skilled services, yet questioned why they are not committed to their profession to the extent that we need them to be and wondered what is missing. Rowe compared his observations of medical students and physical therapist students and shared that medical students’ “passion quotient” does not change significantly during 4 years of medical school. Instead, it is within postprofessional residency training that medical residents become new human beings socialized with passion, an appreciation of their profession, and their role within it, with a particular emphasis on the subculture for their specialty area of practice. Rowe's recommendation to improve passion is requiring mandatory postprofessional residency program immediately after entry-level graduation. He shared his belief that residency training is the most appropriate tool to instill and nurture passion, a recognized critical leadership behavior. He was passionate in his IGNITE to share that it is only through intentional processes that we will be able to successfully instill passion that will lead to transformation of the professional, profession, association, and society. Third Ignite Talk - Walking Towards Our Vision: Are We Over Involved and Under Committed? Dr Michael Majsak, PT, EdD, associate professor and department chair at New York Medical College, recognized for his efforts to establish a DPT/MPH dual degree and for his leadership in integrating IPE curriculum across multiple graduate health professions, offered his IGNITE from an ACAPT representative academic administrator's perspective. He focused his talk on the concept of “education that matters,” a key component of this year's Forum question. Dr Majsak acknowledged that his perspectives are shared by numerous program administrators and confirmed that although we are developing excellent clinical skills in our graduates, we may not be developing reflective practitioners who are prepared to lead, represent our profession to others, and practice effectively in a constantly changing health care system. He encouraged all educators not to “shy away” from these latter essential graduate learning outcomes, but instead reevaluate how we may be over committed in teaching a wide breadth of clinical sciences and under committed to issues of professionalism, leadership, and public health necessary to attain APTA's Vision for the profession, “transforming society by optimizing movement to improve the human experience.” Dr Majsak drew a distinction between being involved versus being committed by sharing the whimsical metaphor that a hen is only involved, but a pig is fully committed in contributing to a breakfast plate of ham and eggs. Similar to the pig, Dr Majsak suggested that being committed means sometimes sacrificing things we intrinsically personally value to achieve higher priority goals, such as visions for future DPT professionals, the profession of physical therapy, and ultimately, the health of society. He challenged all stakeholders involved in physical therapist education to design not only transmissive or transactional learning experiences within DPT programs, but rather transformative learning experiences that result in structural and cultural shifts in how students think, feel, and act as a doctoring professional. Majsak went on to challenge educators to ensure that DPT students have sufficient time and experiences for self-reflection and self-directed learning, interprofessional education, and opportunities in service-based learning to appreciate and value issues in public health policy and management, as well as the social determinants of health that ultimately influence the future success of DPT graduates and our profession. CAFE STYLE DISCUSSIONS Small group café style discussions allowed all participants of the GRJ Forum to have their voices heard in reaction to the keynote address and IGNITE Talks. The discussions were facilitated using an appreciative inquiry approach to inspire purposeful changes based on the best of what currently is and with the potential of generating positive unforeseen outcomes. The focus was not on what was wrong or needed to be fixed but on what worked well. To create positive visioning, participants were encouraged to share success stories related to the discussed topic and to finish sentences such as “How might we…” and “Wouldn't it be great if we could…” Each participant had the opportunity to discuss 2 of 13 topics. The tangible outcomes of the discussions were innovative directions for physical therapy educators to explore. The 13 topics and highlights from the discussions are presented in Table 1. The themes of the discussions were on the intentions for DPT education to graduate physical therapists prepared to lead, and In a of with our group of speakers, and the Forum encouraged all 2016 ELC participants to reflect and consider what each might do to illustrate passion, persistence, and within our own of influence in this we as Dr Stokes with the and as Dr Johnson role for many years, the to act in a manner that will advance physical therapist Dr Johnson the efforts and ideas of the 2016 Forum participants and challenged us to it in some way we can share of actions at where she to evaluate our We for their contribution to the success of the Third Annual GRJ Forum and forward to Education Leadership where we will have opportunities to learn about actions by this year's Forum of this year's GRJ Forum can be on the ACAPT To the Board members of ACAPT and for their collaborative efforts in the To PT, and the for their to the Forum in Dr Geneva R. Johnson's To the table Catherine Mary and to Dr Mary ACAPT Program Committee for the necessary to the GRJ Forum a and to the ELC Program Committee members for keynote conference and space within the Education Leadership Conference for this year's

Background and Purpose. Advances in our understanding of human genetics holds out the promise of significant diagnostic and therapeutic benefits in many fields of medicine, A number of basic questions and issues with respect to genetics and physical therapy practice and education need to he addressed. The purpose of this position paper is to highlight and explore some of those questions and issues, with the objective of advocating for increased education in relevant genetics-related topics and issues for both practicing physical therapists and students enrolled in physical therapist professional (entry-level) education programs. Position and Rationale. The position adopted in this paper is that increased education in relevant genetics-related topics and issues should be a priority for practicing physical therapists and students enrolled in physical therapist professional education programs. The rationale for this position is that in order to practice in the genomics era, health care clinicians should possess certain genetics-related competencies to more effectively manage and care for their patients. Some of the patient-related benefits that will result from an increased level of genetics education and awareness from within the physical therapy profession are the positive shaping of patients' attitudes towards genetic testing and counseling, the provision of accurate genetics information to patients, the generation of appropriate and timely referrals to genetics professionals, and effective advocacy on behalf of patients being discriminated against due to their genetic profiles. Recommendations. The implications of advances in genetics on physical therapist practice and education needs to be considered in a substantive manner. Academicians, clinicians, the American Physical Therapy Association (APTA), and the National Coalition for Health Professional Education in Genetics (NCHPEG) should initiate dialogue to decide on appropriate genetics competencies for the profession. Genetics education should be considered a priority in order for physical therapists to function as effective direct access practitioners and members of the health care team in the genomics era. Key Words: Human Genome Project, Genetics education and physical therapy, Genetics Core Competencies. INTRODUCTION Unprecedented growth in our understanding of human genetics and its role in disease, coupled with recent technological advances such as the advent of powerful gene sequencing and gene mapping techniques, are expected to yield significant diagnostic and therapeutic benefits in many fields of medicine.1-3 Because physical therapists are integral members of the health care team, physical therapist clinicians and educators alike need to consider the impact of genetics on contemporary clinical practice and education, both professional and beyond. In considering the implications of advances in human genetics on physical therapist practice and education, several basic questions need to be addressed. Should physical therapists in clinical practice concern themselves with a patient's genetic information? Are there minimum genetics competencies that clinicians should possess? Should physical therapists be educated in the ethical, legal, and social implications (ELSI) of genomics? In short, should issues relating to clinical genetics remain solely within the domain of the medical geneticist, genetic counselor, and nurse, or do they also need to be considered by physical therapists? The answers to these questions are important because they will ultimately determine the level of genetics education required by members of the physical therapy profession. Leaders in the genetics community have questioned whether primary care physicians are prepared for the incorporation of genetics into mainstream medicine,4 a question that could also be asked of physical therapists. The purpose of this position paper is to highlight and explore some of the questions and issues relating to genetics and physical therapy practice and education, with the objective of advocating for increased education in relevant genetics-related topics and issues for both practicing physical therapists and students enrolled in physical therapist professional education programs. …

Background Development of clinical guidelines in health services is generally considered important for improving and managing the care process (Grimshaw et al., 1995a, Grimshaw et al., 1995b, Grol and Grimshaw 2003, Grol et al., 2004). Clinical guidelines are systematically developed statements designed to help practitioners and patients to make decisions about appropriate health care (Field and Lohr 1992). Higher quality of care and improved cost effectiveness are important goals in guideline development, optimally resulting in improved health (Woolf et al., 1999). Moreover, the process of guideline development addresses the need to decrease variability in professional practice, and practitioners' desire to legitimize their profession in the eyes of external stakeholders (Grimshaw et al., 1995a, Grimshaw et al., 1995b, Grimshaw and Hutchinson 1995, Grol and Grimshaw 2003, Grol et al., 2004). The concept of evidence-based practice, supported by clinical guidelines, is a common aspect of health care today....

BackgroundCountry by country similarities and differences in physical therapy practice exists. Therefore, before updates in practice can be provided, such as trainings in evidence-based practice, it is necessary to identify the profile and nature of practice in a given country or setting. Following a search of the international literature, no appropriate tool was identified to collect and establish data to create the profile of physical therapy practice in the Philippines. We therefore developed, validated and pilot tested a survey instrument which would comprehensively describe the practice of physical therapy in the PhilippinesFindingsWe used a mixed methods design to answer our study aims. A focus group interview was conducted among a group of physical therapists to establish the content and contexts of items to be included in the survey instrument. Findings were amalgamated with the information from the literature on developing survey instruments/questionnaires. A survey instrument was drafted and named as the Physical Therapy Profile Questionnaire (PTPQ). The PTPQ was then validated and pilot tested to a different group of physical therapists.The final version consisted of five separate parts namely (A) General information and demographics, (B) Practice Profile, (C) Treatment Preferences, (D) Bases for clinical work and (E) Bases for educational/research work. At present the PTPQ is relevant to the Philippines and could be used by any country which has a similar nature of practice with the Philippines.ConclusionThe Physical Therapy Practice Questionnaire (PTPQ) was shown to have good face and content validity among the Filipino physical therapists and their context of practice. It has also been found to be useful, easy to administer tool and in a format appealing to respondents. The PTPQ is expected to assist comprehensive data collection to create a profile of physical therapy practice in the Philippines.

Background and purposeNew ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice.DesignThrough a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study.MethodsThe 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators.ResultsThrough data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation.ConclusionInnovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR.

This article presents a model for the educational preparation of physical therapist students that prepares them to take on their role as moral agents. The authors contend that the study of the ethical components of physical therapy practice and the preparation of physical therapist students for their role as moral agents need to take a central position in physical therapy education. A model for the moral education of physical therapist students is presented to address the three primary goals of (1) promoting the development of moral behavior in physical therapist students, (2) promoting the integration of students into the values and behaviors of the profession of physical therapy, and (3) promoting the students' ability to become an active part of a dialogue on the ethical components of physical therapy practice. These three primary goals of an ethics curriculum are described, curricular objectives are discussed, content areas are identified, and recommended instructional strategies are presented.

The Modified Parkinson Activity Scale (PASm) and Lindop Parkinson's Disease Mobility Assessment (LPA) scales were developed to assess the functional mobility in patients with Parkinson's disease (PD) being directly applied to physical therapy practice. To translate and perform the cross-cultural adaptation of PASm and LPA scales to Portuguese-Brazil, and to analyze some psychometric properties. Cross-cultural validation study. Clinical environment. Thirty-two Brazilian subjects with Parkinson's disease. The study consisted of two stages: 1) cross-cultural adaptation process; 2) evaluation of psychometric properties. Considering the total score, the interrater and test-retest reliabilities showed a coefficient of intra-class correlation that ranged between 0.97 and 0.98. Both scales showed excellent internal consistency (α=0.83 and 0.94). Positive correlations were obtained between the Brazilian versions of the LPA and PASm and PAS (ρ=0.63 and 0.92). The concurrent validity between scales and part III of UPDRS, established a moderate negative correlation, (ρ=-0.54 and -0.65). The one way ANOVA showed that LPA-Brazil discriminates the individual with PD between all stages according HY, and the PASm- Brazil between mild and severe stages, and moderate and severe. The MDC of scales ranging from 1 to 2 points. There was Ceiling effect only for the LPA-Brazil. Brazilian versions of PASm and LPA are valid and reliable instruments to assess the functional mobility in patients with PD, being directly applied to physical therapy clinical practice. The major goal of physical therapy in PD is to maintain functional mobility and independence of the patient. The results of study are relevant and could improve the physical therapy practice in Brazil, since it provides the Brazilian version of two mobility scales (one of them recommended by the European Guidelines for Physical Therapy Practice in patients with Parkinson disease).