American Physical Therapy Association Research Articles

Simulation-Based Cardiopulmonary Examination Skills Checklist: Assessment of Inter-rater Reliability

Purpose: Experiential learning using high-fidelity simulation is a valuable tool for teaching Doctor of Physical Therapy (DPT) students the cardiopulmonary examination. There are currently no standardized assessment tools to evaluate student performance and provide feedback on these skills. The cardiovascular and pulmonary section of the American Physical Therapy Association recently published recommended competency levels for entry-level physical therapists including examination skills. The primary aim of this study was to create and assess inter-rater reliability of a cardiopulmonary examination skills checklist that aligns with these recommendations and can be used in the simulation environment. Methods: A skills checklist with 6 sections was developed to assess student performance on the cardiopulmonary examination within a high-fidelity simulation experience. Training videos on the cardiopulmonary examination and checklist use were created and given to 3 graders. Seventy-three DPT students performed the cardiopulmonary examination within simulation while being recorded. Three graders then assessed the same 25 randomly selected videos using the checklist. Inter-rater reliability, item % agreement and student performance were analyzed. Results: The overall interclass correlation coefficient (ICC) of the checklist was calculated to be 0.858, demonstrating strong agreement between graders. The ICC for individualized checklist sections ranged from 0.659 to 0.960, demonstrating good to near perfect agreement. The average percent correct achieved by students was 80.48 (6.91%), R = 65% to 93.33%. There were >80% agreement for 55/60 items and >90% agreement for 44/60 items. Conclusion: The checklist provided an effective tool to assess student performance on the cardiopulmonary examination and demonstrated consistent scoring between graders.

Vital Signs Monitoring in Outpatients Physical Therapy in Various Cities of Pakistan

Every time a new patient or client visits, their vital signs should be taken, according to the American Physical Therapy Association (APTA). Taking vital indicators such as blood pressure, heart rate, breathing rate, and body temperature is part of a physical therapist's professional decision-making process. Objective: To determine the frequency of vital signs monitoring in outpatients physical therapy practice. Methods: A descriptive cross-sectional study was conducted in physical therapy departments of different clinical settings. Data were collected through 12 items survey questionnaire from physical therapist, which was then analyzed by SPSS version 2022.The frequency of monitoring of vital signs by physical therapist was measured by using frequency tables. Association was seen with the help of chi-square test. Results: In this survey study, 12 items and 300 respondents were included to find out the frequency of physical therapist who monitor vital signs in their daily practice. The results suggested that 56.7% respondents monitor vital signs, 27.3% respondents monitor vitals only when there is an indicted or diagnosed cardiovascular condition and 16.0% respondent do not monitor vital signs. There is a significant relation that vital signs are neglected due to time constraints in daily practice with p-value less than 0.05. Conclusions: This study demonstrated that vital signs are being monitored by most of the physical therapist. Further studies need to conducted and better stratify risk factors for different conditions to better determine when exercise and activity may be at risk.  

Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline from the American Physical Therapy Association.

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention.

Physical Therapists' Acceptance of a Wearable, Fabric-Based Sensor System (Motion Tape) for Use in Clinical Practice: Qualitative Focus Group Study.

Low back pain (LBP) is a costly global health condition that affects individuals of all ages and genders. Physical therapy (PT) is a commonly used and effective intervention for the management of LBP and incorporates movement assessment and therapeutic exercise. A newly developed wearable, fabric-based sensor system, Motion Tape, uses novel sensing and data modeling to measure lumbar spine movements unobtrusively and thus offers potential benefits when used in conjunction with PT. However, physical therapists' acceptance of Motion Tape remains unexplored. The primary aim of this research study was to evaluate physical therapists' acceptance of Motion Tape to be used for the management of LBP. The secondary aim was to explore physical therapists' recommendations for future device development. Licensed physical therapists from the American Physical Therapy Association Academy of Leadership Technology Special Interest Group participated in this study. Overall, 2 focus groups (FGs; N=8) were conducted, in which participants were presented with Motion Tape samples and examples of app data output on a poster. Informed by the Technology Acceptance Model, we conducted semistructured FGs and explored the wearability, usefulness, and ease of use of and suggestions for improvements in Motion Tape for PT management of LBP. FG data were transcribed and analyzed using rapid qualitative analysis. Regarding wearability, participants perceived that Motion Tape would be able to adhere for several days, with some variability owing to external factors. Feedback was positive for the low-profile and universal fit, but discomfort owing to wires and potential friction with clothing was of concern. Other concerns included difficulty with self-application and potential skin sensitivity. Regarding usefulness, participants expressed that Motion Tape would enhance the efficiency and specificity of assessments and treatment. Regarding ease of use, participants stated that the app would be easy, but data management and challenges with interpretation were of concern. Physical therapists provided several recommendations for future design improvements including having a wireless system or removable wires, customizable sizes for the tape, and output including range of motion data and summary graphs and adding app features that consider patient input and context. Several themes related to Motion Tape's wearability, usefulness, and ease of use were identified. Overall, physical therapists expressed acceptance of Motion Tape's potential for assessing and monitoring low back posture and movement, both within and outside clinical settings. Participants expressed that Motion Tape would be a valuable tool for the personalized treatment of LBP but highlighted several future improvements needed for Motion Tape to be used in practice.

Visibility of Entry-Level Doctor of Physical Therapy Program's Mission, Vision, and Value Statement and Alignment with Professional Values

Introduction: This study aimed to assess the accessibility and alignment of core statements (mission, vision, and values) in entry-level Doctor of Physical Therapy (DPT) programs across the United States with the core beliefs of the American Physical Therapy Association (APTA). Methods: Two independent reviewers searched publicly available resources for the core statements of 271 Commission on Accreditation in Physical Therapy Education accredited DPT programs. The statements were cross-referenced against APTA Standards of Practice and Core Values. Descriptive statistical analysis assessed the public availability of program statements and their alignment with APTA core beliefs. Results: Among the programs, 95.6% had mission statements, 63.5% had assessable vision statements, and 58.7% had easily assessable value statements. The most common APTA core beliefs were Education, Excellence, Responsibility, and Evidence-Based Practice. Altruism, Advocacy, Duty, and Patient and Client Management were less prevalent. Discussion: The visibility and accessibility of core statements in DPT programs across the United States are low. Given their role in program accreditation, promoting transparency is crucial. Limited visibility hindered the concluding alignment of core statements and APTA core beliefs. Nonetheless, this information can motivate schools to enhance core statements for better alignment. Our study emphasizes the need for increased transparency of core statements in DPT programs, fostering informed decision making. Addressing these issues can facilitate better alignment with APTA principles in physical therapy education and practice.

Physical therapist awareness of diagnostic imaging referral jurisdictional scope of practice: an observational study

ABSTRACT Objectives To examine physical therapist awareness and utilization of imaging referral privileges in the United States (US) and how it relates to direct access frequency. Methods This study utilized survey data collected in 2020–2021 from US physical therapists. Subjects were asked about imaging referral jurisdictional authority in their state. Responses were analyzed for accuracy and compared to the level of jurisdictional authority and its impact on imaging referral. Analysis of imaging skills performance and imaging referral practices were compared to direct access frequency.  Results Only 42.0% of physical therapists practicing in states that allow imaging referral were aware of this privilege. Those practicing where imaging referral was allowed via state legislation were significantly more likely (p < 0.01) to be aware of this privilege (71.4%) compared to those granted by the state board (25.2%). Those aware of their imaging referral scope were more likely (p < 0.01) to practice imaging referral (44.5%) compared to those who were unaware (3.2%). Direct access frequency was positively associated with imaging skill performance and imaging referral practice (p < 0.01). Doctors of Physical Therapy, residency/fellowship-trained physical therapists, and board-certified physical therapists all reported practicing greater frequency of direct access (p < 0.01). Discussion/Conclusion There is a striking lack of awareness of imaging privileges among physical therapists as influenced by the level of jurisdictional scope. These results suggest that the lack of awareness may have a dampening effect on diagnostic imaging referrals. The American Physical Therapy Association should consider engaging with state boards to raise imaging privilege awareness.

Development of a Physical Therapy Telehealth Examination Battery for People with Parkinson Disease.

The rapid transition to telehealth following the COVID-19 pandemic raised challenges for remote delivery of physical therapy. One challenge was identifying outcome measures for people with Parkinson Disease (PwP) that could safely be conducted via telehealth. This paper evaluates the feasibility of a telehealth physical therapy examination battery for PwP in early to middle stage of disease progression. We reviewed recommended outcome measures from the American Physical Therapy Association's Academy of Neurologic Physical Therapy (ANPT) Parkinson Evidence Database to Guide Effectiveness (EDGE) document and evaluated their appropriateness for remote administration. A clinical decision tree was created to streamline the examination process, incorporating elements of the ANPT movement analysis of tasks as a movement screen. The examination battery was then conducted on three PwP and evaluated for safety and feasibility. This physical therapy telehealth examination battery provides physical therapists with a method to conduct safe and efficient remote assessments for PwP.

Heel Pain - Plantar Fasciitis: Revision 2023.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain. J Orthop Sports Phys Ther 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303.

Mastering Our Own Magic in the Evolution Toward Precision Practice.

Edelle (Edee) Field-Fote, PT, PhD, FASIA, FAPTA, the 54th Mary McMillan lecturer, is director of the Shepherd Center Spinal Cord Injury Research Program & Hulse Laboratory; professor in the division of physical therapy at Emory University School of Medicine; and professor of the practice in the school of biological sciences at the Georgia Institute of Technology. In her role as the director of spinal cord injury (SCI) research at Shepherd Center, Field-Fote leads a team dedicated to improving motor function in people with SCI through the development of neuromodulation and neurorehabilitation approaches informed by the latest neuroscience research and guided by outcomes that have meaning for people with SCI. With a clinical background as a physical therapist, PhD training in a preclinical model of SCI, and postdoctoral training in motor control physiology, her 25-plus years of SCI research have spanned the breadth of basic and clinical/translational research related to SCI. Dr Field-Fote has conducted randomized clinical trials with funding from the National Institutes of Health since 1997; other clinical trials in her lab have been funded by the Department of Defense, the National Institute on Disability Independent Living and Rehabilitation Research, and numerous foundations. Field-Fote is the recipient of multiple honors from the American Physical Therapy Association (APTA) and its components. She is a Fellow of APTA and a Fellow of the American Spinal Injury Association. She has also served in numerous APTA and APTA component appointed or elected positions and as a member and president of the Foundation for Physical Therapy Research Board of Trustees.

Musculoskeletal Ultrasound for the Diagnosis of Plantar Fasciitis: An Accuracy and Diagnostic Yield Study.

To evaluate the accuracy of musculoskeletal ultrasound measurement of plantar fascia thickness and shear wave elastography (SWE) calculation of Young's modulus in the diagnosis of plantar fasciitis (PFis), and to explore whether it will have any impact on clinical decision-making, rather than just using established diagnostic methods of clinical symptoms and signs. A diagnostic single-center study was conducted in 60 patients with PFis and 64 patients with other types of heel pain. The sensitivity and specificity of musculoskeletal ultrasound in the diagnosis of PFis were calculated according to the diagnostic criteria for PFis recommended by the Clinical Practice Guide for PFis of the American Physical Therapy Association (APTA) Orthopaedic Branch. The analysis of the receiver operating characteristic curve of the subjects was used to study the accuracy of the diagnosis of PFis by two indicators alone and two indicators jointly. The thickness of plantar fascia measured by musculoskeletal ultrasound and the area under the curve (AUCs) calculated by shear wave elastography for diagnosing PFis were 0.925 and 0.917, respectively, and the optimal cutoff values were 3.15 mm (sensitivity: 100.0%, specificity: 81.3%) and 63.24 kPa (sensitivity: 78.3%, specificity: 92.2%), respectively. The area under the curve (AUCs) for the combined diagnosis of the two is 0.973 (sensitivity: 93.3%, specificity: 93.8%). The thickness of plantar fascia measured by musculoskeletal ultrasound and Young's modulus calculated by SWE have high accuracy in diagnosing PFis, and the combined diagnosis of the two can improve the diagnostic accuracy of patients with PFis.

Research Agenda for Physical Therapy From the American Physical Therapy Association.

The Research Agenda for Physical Therapy From APTA identifies research priorities within the profession vital to advancing the practice and profession of physical therapy. The research agenda has 6 key areas of focus: population health research, mechanistic research, clinical research, education and professional development research, health services research, and workforce research. Researchers, funding agencies, and public policy makers can use the research agenda to concentrate research efforts around these areas.

A Mobile Application Prototype Designed to Support Physical Therapy Assessment Learning Processes

The present work is the result of applied research, which describes how the physical therapy program at the Universidad Santiago de Cali approached the support of the learning processes from the Guide to Physical Therapist Practice issued by the American Physical Therapy Association (APTA) from a teaching perspective using information technologies with an emphasis on mobile devices (D-Learning). The implementation process was conducted using the PSP (Personal Software Process) methodology, condensing its six characteristic moments to address the problem in four stages: planning, design, development, and validation, corresponding to phases 2 and 3 of the interdisciplinary project developed by and between the Schools of Engineering and Health Sciences, thereby understanding that the remaining phases exceed the scope of this paper (these phases include a systematic review, an analysis, and feedback from the academic community). A preliminary assessment describes the knowledge gathering and idea conception processes, as well as the solution design process in Enterprise Architect. Subsequently, the prototype was implemented, the corresponding documentation was prepared, and its usability was validated by the academic community at the university. Therefore, a supporting tool was generated, focusing specifically on learning about the Guide to Physical Therapist Practice.

The Case for Developing a Movement System Framework for Older Adults.

Leaders and scholars from multiple academies of the American Physical Therapy Association are developing and defining movement system diagnoses to guide practice. However, there is no consensus on the need for or content of such frameworks. This Perspective describes current thought about movement system diagnoses in physical therapy and summarizes the work of the Academy of Geriatrics (APTA Geriatrics) Movement System Diagnosis Task Force (GMS-TF) as it contributes to the movement system diagnosis discussion within the profession. Initially convened to define movement system diagnostic labels unique to older adults, the GMS-TF's developmental process identified the need for a clearer diagnostic framework onto which specific diagnoses will later be added. Although The World Health Organization International Classification of Functioning, Disability and Health model is a strong foundation for the patient-client management model, the GMS-TF proposes formal incorporation of the Geriatric 5Ms (mobility, medications, memory, multi-complexity, and "what matters most") into a movement system framework for older adults. The GMS-TF concurs with the APTA Academy of Neurology Movement System Task Force proposal that observation and analysis of key functional tasks are the foundation of any examination of older adults. The GMS-TF suggests adding several additional movement tasks that are important for older adults. The GMS-TF believes that this strategy highlights the health care needs of older adults and prioritizes physical therapist care for older adults with complex needs. This Perspective is the foundation for a future movement system diagnosis model for older adults that will complement and facilitate the development of models of care to be applied across the lifespan.

Effects of strength training on functional ambulation following knee replacement: a systematic review, meta-analysis, and meta-regression

Strength training is recommended by the American Physical Therapy Association to improve muscle strength, mobility, and balance following knee replacement. Few studies have focused on the direct effects of strength training on functional ambulation, and potential dose–response relationships between strength training parameters and the effect remain unclear. The aim of this systematic review, meta-analysis, and meta-regression was to evaluate the effects of strength training on functional ambulation following knee replacement (KR). We also aimed to explore potential dose–response relationships between strength training parameters and performance in functional ambulation. A systematic literature search of eight online databases was performed on March 12, 2023, for randomized controlled trials evaluating the effects of strength training on functional ambulation by six-minute walk test (6MWT) or timed-up and go test (TUG) after KR. Data were pooled by random-effect meta-analyses and presented as weighted mean difference (WMD). A random-effect meta-regression was performed for four predetermined training parameters, namely, duration (weeks), frequency (sessions per week), volume (time per session), and initial time (after surgery) separately to explore dose–response relationships with WMD. Fourteen trials encompassing 956 participants were included in our study. Meta-analyses showed an improvement in 6MWT performance after strength training (WMD: 32.15, 95% CI 19.44–44.85) and a decrease in time to complete TUG (WMD: − 1.92, 95% CI − 3.43 to − 0.41). Meta-regression revealed a dose–response relationship only between volume and 6MWT, with a decreasing trend (P = 0.019, 95% CI − 1.63 to − 0.20). Increasing trends of improvement in 6MWT and TUG were observed with increasing training duration and frequency. A slight decreasing trend of improvement was observed in 6MWT with postponed initial time, while an opposite trend was observed in TUG. Based on existing studies, moderate-certainty evidence suggests that strength training could increase 6MWT distance, and low-certainty evidence shows that strength training could decrease the time to complete TUG after KR. Meta-regression results only suggested a dose–response relationship between volume and 6MWT with a decreasing trend.Registration: PROSPERO: CRD42022329006.

How do practicing physical therapists perceive anatomy education?

The purpose of this investigation was to explore the perceptions of the sufficiency and relevancy of physical therapy anatomy education among early, mid, and late career physical therapists. A survey was distributed via email through clinical networks in the greater Mid-Atlantic region, the American Physical Therapy Association Pennsylvania chapter (APTA-PA), and the American Council of Academic Physical Therapy (ACAPT) Educational Research division. 194 physical therapists responded to the survey. The survey included questions regarding how anatomy was learned in physical therapy school and Likert scale questions investigating opinions of anatomy education. Frequencies were calculated to determine the methods of anatomy education and Likert scale responses. One-way Analysis of Variance (ANOVA) was performed to compare the Likert scale responses from the groupings of survey participants. Respondents across all years of practice felt that their anatomy education was sufficient and relevant to their clinical practice and that schools dedicated enough time to teaching anatomy. Respondents who had a dissection component in their anatomy curriculum were more likely to view dissection as essential. Length of time in practice did not influence opinions on the sufficiency or relevancy of anatomy education. Dissection continues to be included in most physical therapy anatomy courses and perceived as essential for learning. Practicing physical therapists' anatomy education was viewed as sufficient and relevant with few recommendations for change. Perceptions of clinicians should be incorporated into curriculum design and reform and be gathered on an ongoing basis as more students from programs without anatomical donors graduate and enter clinical practice.

Physical Therapist Management of Glenohumeral Joint Osteoarthritis: A Clinical Practice Guideline from the American Physical Therapy Association.

A clinical practice guideline on glenohumeral joint osteoarthritis was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists, an occupational therapist, and a physician. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for physical therapist management of glenohumeral joint osteoarthritis. This clinical practice guideline is available in Spanish; see Supplementary Appendix 8.

Tennis Elbow: What Is It? How Do I Get Back to My Regular Activities?

You do not have to play tennis to get tennis elbow-a very common problem for people who do lots of repetitive movements of the wrist, forearm and elbow, such as carpentry, painting or racquet sports. Most people with tennis elbow feel pain on the outside of their elbow and upper forearm. Experts in managing elbow pain developed a guideline for rehabilitation clinicians to use to help you understand more about tennis elbow. Here, we explain what the guidelines say about how to diagnose tennis elbow (sometimes called lateral elbow pain or lateral elbow tendinopathy), the specific treatments your physical therapist might offer you to help manage pain and improve the mobility of your elbow, and the types of exercises you could do to strengthen the muscles in your wrist and forearm.

Effect of Yoga Among Women at Risk and With Breast Cancer–Related Lymphedema: A Systematic Review

Background: Participation in exercise improves function, restores fitness, and enhances quality of life in survivors of breast cancer. There is robust evidence regarding resistance and aerobic training for women at risk for and with breast cancer–related lymphedema; however, the effect of yoga on impairments and functional outcomes has not been well documented. The purpose of this systematic review is to examine the effect of yoga on arm volume, strength, range of motion, function, and quality of life among women at risk for and with breast cancer–related lymphedema and create evidence-based recommendations. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Prospero registration number: 42022311574). EMBASE, PubMed, CINAHL Complete, Web of Science, Scopus, and Google Scholar were searched from January 2010 through December 2021. Quality and bias of included studies were assessed using the American Physical Therapy Association's Critical Appraisal Tool for Experimental Intervention Studies. Results: A total of 132 articles were screened for eligibility and 9 studies met inclusion criteria. Based on 3 acceptable and 6 low-quality studies, this review found that participation in yoga demonstrated a positive effect on arm range of motion, strength, function, and quality of life among women at risk for and with breast cancer–related lymphedema. No safety issues, including new onset or exacerbation of lymphedema, were found in the reviewed studies. Conclusion: Integration of yoga into a therapeutic plan of care is supported. Variations in yoga type, mode, duration, and frequency currently make it challenging to generate specific guidelines. Adherence and an ongoing commitment to yoga practice may promote long-term effects.

Professional Experience Related to Self-Assessed Teaching Effectiveness Among Physical Therapist Clinical Instructors.

Physical therapist (PT) students learn through clinical practice with the supervision of a clinical instructor (CI). Clinical instructors have teaching, education, and practice experiences that can positively affect their self-assessed clinical teaching effectiveness (CTE), which may improve learning outcomes for students. Identifying CI experiences, such as specific teaching, education, or practice expertise, as they relate to effective clinical teaching may be beneficial in the selection of PT CIs and allow instructors to focus on professional experiences that will elevate their self-assessed teaching abilities. The study included 851 PTs from a large geographical area. The participants had varying educational, clinical, and professional experiences and each had been a CI for at least 1 student clinical education experience. Specific PT CI professional experiences associated with CTE were determined through a correlation study using quantitative data collected online through a validated survey instrument, the Clinical Teaching Effectiveness Questionnaire. This study examined degree earned, PT residency and PT fellowship training, the American Board of Physical Therapy Specialties (ABPTS), American Physical Therapy Association (APTA) Credentialed Clinical Instructor Program (CCIP) level 1 and level 2, years of clinical experience, number of students taught, and number of years of clinical teaching. Results indicated that a higher level of self-assessed CTE was associated with ABPTS certification, CCIP level 1 and level 2, and a higher number of students mentored by a CI. Physical therapist residency training, PT fellowship training, years of clinical experience, and number of years of clinical teaching were not related to self-assessed CTE. Specific teaching, clinical, and practice experiences were related to CTE. To increase PT CI CTE, CIs are encouraged to consider ABPTS certification, CCIP level 1 and level 2, and mentoring students regularly. The PT profession, APTA, and Doctor of Physical Therapy programs should support these endeavors.

Utilization of Clinical Practice Guideline Interventions in the Conservative Management of Mechanical Neck Pain: A Retrospective Analysis.

Neck pain is a common musculoskeletal condition frequently treated by physical therapists. The American Physical Therapy Association (APTA) published a clinical practice guideline (CPG) in 2008 with a revision in 2017 to improve the diagnosis and treatment of neck pain. One subset of neck pain in the CPG is "Neck Pain with Mobility Deficits," also called mechanical neck pain. Little data exists on the adherence of physical therapists to the CPG-recommended treatments for neck pain as well as the outcomes associated with the utilization of the CPG. The purpose of this study is to examine both CPG treatment adherence and associated outcomes in patients treated for mechanical neck pain by physical therapists in the outpatient setting. Retrospective chart review of patients (n=224) who received physical therapy for neck pain between 2018 and 2022. Data ranges were chosen due to the publication of the CPG revision in 2017. Six interventions for mechanical neck pain from the CPG were examined: thoracic manipulation, cervical mobilization, transcutaneous electrical stimulation (TENS), dry needling, advice to stay active, and scapular resistance exercises. The exclusion criteria were a history of cervical spine surgery. Other data collected included age, sex, characteristics of the evaluating physical therapist, and the number of visits. For CPG treatment adherence, 4.5% of patients received thoracic manipulation, 47.8% of patients received cervical mobilization, 12.5% of patients received TENS, 22.8% of patients received dry needling, 99.1% of patients received advice to stay active, and 89.3% of patients received scapular resistance exercises. There was no significant improvement in pain, range of motion (ROM), and function based on a number of CPG interventions used during the bout of physical therapy (p=0.17to p=0.74). Patients who were evaluated by a physical therapist who was an Orthopedic Certified Specialist (OCS) were more likely to receive more interventions recommended by the CPG (p<0.01). CPG-recommended treatments are used with varying frequency by physical therapists when treating mechanical neck pain. Thoracic manipulation is rarely used while scapular resistance exercises are frequently used. There was no significant improvement in pain, ROM, or function based on the number of CPG-recommended treatments used during the bout of physical therapy.