Therapist Interventions Research Articles

How do parents frame their engagement experience in early intervention? A grounded theory study

Purpose Parent and therapist engagement and partnership are critical in early intervention physiotherapy and occupational therapy for infants with cerebral palsy to improve outcomes. The main aim of this study was to understand how parents perceive their engagement experience in early intervention over time. Methods Grounded theory methodology was used. Twenty parents of diverse backgrounds participated in 22 interviews (including some repeated longitudinally) to reflect on their engagement experience within the context of early intervention community services provided in the UK NHS. Results The findings highlight how parents’ perspectives of their engagement in EI change according to critical circumstances, including their preceding neonatal trauma, the at-risk CP label, firmer diagnosis of CP and their child’s response to intervention. We theorise that this disrupted transition experience to parenthood becomes part of parental framing (or sense-making) of their engagement in EI. Overlapping frames of uncertainty, pursuit and transformation capture and explain nuances in parents’ engagement patterns within EI over time. Conclusion This theorising has implications for early intervention therapists in how they engage in the lives of families and partner with parents to support healthier parental transition, wellbeing and subsequent improved infant outcomes.

Potential Role of Occupational Therapist Intervention in Elementary School for Children with Additional Support Needs: A Systematic Review.

(1) Background: The main activity children engage with is learning through play or formal education. The aim of this systematic review is to analyze the role of occupational therapy in the school setting for children with additional support needs or disabilities. (2) Method: We conducted a systematic review using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. This systematic review was registered in PROSPERO (CDR42022314271). The search was performed in the following databases: ERIC, Dialnet Plus, PubMed, OTseeker, Cochrane, Scopus, CINAHL, and PsycINFO. (3) Results: In total, 1954 studies were identified, from which 18 articles were selected. These studies were heterogeneous and showed different types of intervention of the occupational therapist in school environments. (4) Conclusions: The main conclusions highlighted the effectiveness of the occupational therapist within the school environment, the importance of an interdisciplinary team to cover the special needs students within the school and the need for intrinsic motivation for an active and inclusive participation of the students with special needs. However, there is a need for more homogeneous studies with a larger sample size that specifically focus on the school context and include the involvement of occupational therapists in order to replicate the findings obtained.

Cultural reflexivity and the referral problem: A discourse analysis of three initial sessions of intercultural couple therapy

AbstractUsing a combination of macro‐ and micro‐analytic approaches in discourse analysis, this article examines transcripts from three initial sessions of DVD‐recorded conjoint couple therapy with an intercultural couple. We analyse the strategies of power employed by therapy participants to promote their preferred construction of the referral problem. Focusing on the intersections of gender, psychopathology and culture, we explore how wider sociocultural discourses play out in the micro‐context of participants' discursive exchanges. We also consider how the therapist's interventions privilege and marginalise client discourses in both strategic and unintended ways. This article offers some clinical techniques to address the dilemmas and difficulties identified in our analysis. We conclude by underscoring the value of reviewing recordings and transcripts of therapy dialogues to enhance cultural reflexivity.

Effects of Therapist Intervention during Upper-Extremity Robotic Rehabilitation in Patients with Stroke.

This study aimed to determine whether the treatment effect differs for patients with stroke who perform robot-assisted upper-extremity rehabilitation by themselves compared to those whose rehabilitation is actively assisted by a therapist. Stroke patients with hemiplegia were randomly divided into two groups and received robot-assisted upper-limb rehabilitation for four weeks. In the experimental group, a therapist actively intervened in the treatment, while in the control group, the therapist only observed. After four weeks of rehabilitation, the manual muscle strength, Brunnstrom stage, Fugl-Meyer assessment of the upper-extremity (FMA-UE), box and block test, and functional independence measure (FIM) showed significant improvement in both groups compared to that before treatment; however, no interval change in spasticity was noted. The post-treatment values showed that the FMA-UE and box and block tests were significantly improved in the experimental group compared to those in the control group. Comparing the changes in the pre- and post-treatment values, the FMA-UE, box and block test, and FIM of the experimental group were significantly improved compared to those in the control group. Our results suggest that active intervention by therapists during robot-assisted upper-limb rehabilitation positively impacts upper-extremity function outcomes in patients with stroke.

Aspectos da atuação do terapeuta ocupacional no contexto hospitalar no primeiro ano da pandemia de COVID-19

Abstract Introduction The COVID-19 disease caused a pandemic, generating an overload on health services, especially in hospital institutions, due to the need for hospitalization of infected patients. Among health professionals, the occupational therapists have contributed to coping with the disease. Objective To verify the performance of occupational therapists in hospital contexts in the first year of the COVID-19 pandemic. Method This is a cross-sectional, exploratory, descriptive study with a quantitative approach. The research was developed using Google Forms®, with data collection through a questionnaire with open and closed questions, with occupational therapists working in hospital care as participants. Data were described and statistically analyzed using Statistica 9.1 software and Fisher's exact test. Results 36 occupational therapists participated, of which 23 treated patients with COVID-19 (63.9%). Of the participants, 75% responded that they modified their intervention with the onset of the pandemic and 91.7% considered their role fundamental during this period. The percentage of therapists who consider their performance as an occupational therapist fundamental during the pandemic in the group that worked with patients with COVID-19 (p=0.040) is significantly higher compared to the group that did not work with patients with COVID-19 (76.9%). In caring for patients with COVID-19, most occupational therapists responded that their role was specific to the scope of their profession (86.9%) and important in combating the disease (60.8%). Conclusion The results bring enlightening data about the interventions of occupational therapists, leading to critical-reflective discussions about the need to appropriate a new practice in a hospital context.

Empirical study on the effectiveness of online groups using a mobile health application for middle-aged and older adults to continue exercising.

[Purpose] This study aimed to determine the effects of a mobile health application, and exercise instructions by a physical therapist on exercise frequency, duration, and intensity for middle-aged and older adults. [Participants and Methods] The study included males and females in their 50s to 70s, who provided consent to participate. Thirty-six people who wished to participate in the online group were divided into groups of five or six each, with a physical therapist as group leader. The frequency, intensity, duration of exercise, and group activities were surveyed using questionnaires: before coronavirus disease (COVID-19) (before March 2020, when the novel coronavirus began to spread in Japan), during COVID-19 (after April 2020), after digital versatile disc (DVD) distribution, and after online group initiation (3 weeks after DVD distribution for the control group). [Results] The online group received significantly more frequent instructions by a physiotherapist than the control group. The control group did not show significant changes over time, whereas the online group exercised significantly, more frequently after the intervention. [Conclusion] The online mode and physical therapist intervention resulted in a significant increase in exercise frequency. Exercise advice from professionals and peer presence to continue exercising together were beneficial.

Rural Early Intervention Therapists’ Perceptions of Emergency Remote Telehealth Use

<h3>Research Objectives</h3> To investigate the use of emergency remote telehealth by occupational and physical therapists in rural early intervention setting. To determine what supports are needed to facilitate effective telehealth use by occupational and physical therapists working in a rural early intervention setting. <h3>Design</h3> The purpose of this mixed-methods study was to collect and evaluate the perceptions of practicing early intervention occupational and physical therapists' when implementing emergency remote services via telehealth. In addition, this study determined what resources (i.e., webinars, directions, etc.) are deemed beneficial to increase use of telehealth within therapy settings. <h3>Setting</h3> Occupational therapists and physical therapists were surveyed. Inclusion criteria required participants to be working in a rural, early intervention setting. <h3>Participants</h3> A convenience sample was obtained through the statewide early intervention provider. The survey reached approximately 180 occupational and physical therapists and 65 therapists participated. Demographic information was not collected from the participants to maintain anonymity. <h3>Interventions</h3> Participants voluntarily completed the electronic survey that was shared via an anonymous survey link. Twelve survey questions collected qualitative and quantitative data. <h3>Main Outcome Measures</h3> Data was collected and analyzed comparing the perceptions of occupational therapist and physical therapists. Qualitative questions were analyzed, coded and grouped by common themes. <h3>Results</h3> Occupational therapists generally ranked their abilities and comfort levels with administering assessments via telehealth lower than physical therapists. Suggested future supports for telehealth services included: in person training, webinars, IT training, mentoring. There were variations identified between the two professions surveyed in terms of future telehealth use with some indicating it was a detriment to delivery of services with others indicating it could be an option used in the post-pandemic setting. <h3>Conclusions</h3> Results of this research emphasized the high demand for continued education and training in the use of telehealth to address knowledge and skills gaps in occupational therapists and physical therapists working in rural, early intervention settings. Additional research on this topic would assist in expanding access for clients to the professions of occupational and physical therapy in rural areas. <h3>Author(s) Disclosures</h3> No known conflicts.

Comparing an Expanded Versus Brief Telehealth Physical Therapist Intervention for Knee Osteoarthritis: Study Protocol for the Delaware PEAK Randomized Controlled Trial.

The purpose of this study is to investigate whether a remotely delivered physical therapist intervention increases physical activity (PA) over 12weeks, compared with existing web-based resources, in adults with knee osteoarthritis (OA). This will be a single-center, randomized controlled trial with 2 parallel arms: (1) the Expanded Intervention (Delaware PEAK [Physical Exercise and Activity for Knee osteoarthritis]), which includes five 45- to 60-minute video conference-based sessions of supervised exercise (strengthening exercises, step goals) that are remotely delivered over 12weeks by a physical therapist; or (2) the Brief Intervention (control group), a website that includes prerecorded videos directing participants to web-based resources for strengthening, PA, and pain management for knee OA that are freely available. The trial will enroll 100 participants who meet the National Institute for Health and Care Excellence OA clinical criteria (≥45years old, have activity-related knee pain, and have no morning stiffness or it lasts ≤30minutes), reside in the contiguous United States (excluding Alaska and Hawaii), and are seeking to be more physically active. Outcomes include PA (time in moderate-to-vigorous and light PA, steps per day), sedentary behaviors, treatment beliefs, and self-efficacy for exercise. Our primary outcome is moderate-to-vigorous PA. Outcomes will be measured at baseline, 12weeks, and 24weeks. This protocol focuses on the remote delivery of physical therapy via telehealth to adults with knee OA and comes at a critical time, because the burden of inactivity is of particular concern in this population. If successful, the findings of this work will provide strong support for the broad implementation of Delaware PEAK, highlight the utility of telehealth in physical therapy, and address the critical need to utilize exercise to manage adults with knee OA through physical therapists.

MusicTeamCare (MTC): Theory and practice of clinical intervention for music therapists offering remote support to clients during emergencies

The COVID-19 pandemic meant that people’s lives and work changed significantly across the world. Governments took measures such as social distancing, lockdowns and quarantine protocols to stem the spread of the pandemic. This had a significant impact on music therapy clinical practice, generating reflections and adaptations among the worldwide music therapy community, with several studies still underway. A number of professional music therapy organisations have explored methods for carrying out remote interventions. MusicTeamCare is an approach developed by three Italian Certified Music Therapists that could offer access to support in emergency and crisis situations. This approach is rooted in receptive music therapy theory, with particular reference to Guided Imagery and Music (GIM). MusicTeamCare was used for the first time in March to April 2020, with healthcare workers in Italy who were treating COVID-19 patients. This article outlines theoretical framework, development and evaluation phases of MusicTeamCare. Detailed explanations are given of the theoretical framework, methods of musical analysis, assessment and evaluation strategies, criteria for constructing the playlists and interactive triangulation between the Music Therapists in the research team.

A Comparison Between Clinical Guidelines and Real-World Treatment Data in Examining the Use of Session Summaries: Retrospective Study.

BackgroundAlthough behavioral interventions have been found to be efficacious and effective in randomized clinical trials for most mental illnesses, the quality and efficacy of mental health care delivery remains inadequate in real-world settings, partly owing to suboptimal treatment fidelity. This “therapist drift” is an ongoing issue that ultimately reduces the effectiveness of treatments; however, until recently, there have been limited opportunities to assess adherence beyond large randomized controlled trials.ObjectiveThis study explored therapists’ use of a standard component that is pertinent across most behavioral treatments—prompting clients to summarize their treatment session as a means for consolidating and augmenting their understanding of the session and the treatment plan.MethodsThe data set for this study comprised 17,607 behavioral treatment sessions administered by 322 therapists to 3519 patients in 37 behavioral health care programs across the United States. Sessions were captured by a therapy-specific artificial intelligence (AI) platform, and an automatic speech recognition system transcribed the treatment meeting and separated the data to the therapist and client utterances. A search for possible session summary prompts was then conducted, with 2 psychologists validating the text that emerged.ResultsWe found that despite clinical recommendations, only 54 (0.30%) sessions included a summary. Exploratory analyses indicated that session summaries mostly addressed relationships (n=27), work (n=20), change (n=6), and alcohol (n=5). Sessions with meeting summaries were also characterized by greater therapist interventions and included greater use of validation, complex reflections, and proactive problem-solving techniques.ConclusionsTo the best of our knowledge, this is the first study to assess a large, diverse data set of real-world treatment practices. Our findings provide evidence that fidelity with the core components of empirically designed psychological interventions is a challenge in real-world settings. The results of this study can inform the development of machine learning and AI algorithms and offer nuanced, timely feedback to providers, thereby improving the delivery of evidence-based practices and quality of mental health care services and facilitating better clinical outcomes in real-world settings.

Developing a method to assess fidelity to a complex vocational rehabilitation intervention in the FRESH trial: a feasibility study

BackgroundDetermining whether complex rehabilitation interventions are delivered with fidelity is important. Implementation fidelity can differ between sites, therapists delivering interventions and, over time, threatening trial outcomes and increasing the risk of type II and III errors. This study aimed to develop a method of assessing occupational therapists’ fidelity to deliver a complex, individually tailored vocational rehabilitation (VR) intervention to people with traumatic brain injury (TBI) and assess the feasibility of its use in a randomised controlled trial.MethodsUsing mixed methods and drawing on the intervention logic model, we developed data collection tools to measure fidelity to early specialist TBI VR (ESTVR). Fidelity was measured quantitatively using intervention case report forms (CRF), fidelity checklists and clinical records. Qualitative data from mentoring records, interviews with intervention therapists, participants with TBI, employers and NHS staff at trial sites explored moderators of implementation fidelity. The conceptual framework of implementation fidelity (CFIF) guided measurement and analysis of and factors affecting fidelity. Data were triangulated and benchmarked against an earlier cohort study.ResultsFidelity to a complex individually tailored VR intervention could be measured. Overall, OTs delivered ESTVR with fidelity. Different fidelity measures answered different questions, offering unique insights into fidelity. Fidelity was best assessed using a fidelity checklist, intervention CRFs and clinical notes. The OT clinical notes and mentoring records were best at identifying fidelity moderating factors. Interviews added little insight into fidelity moderating factors over and above mentoring or clinical records. Data triangulation offered a comprehensive assessment of fidelity, highlighting limitations of measurement methods and learning for future trials but was resource intensive. Interviews, fidelity visits and analysing clinical notes were also resource intense. Comparing fidelity data to a benchmark and using CFIF as a framework for organising the fidelity assessment helped.ConclusionsOTs delivered the VR intervention with fidelity. A fidelity checklist and benchmark plus mentoring may offer a practical and effective way of measuring fidelity and identifying fidelity moderating factors in trials of complex individually-tailored rehabilitation interventions. Mentoring provided real-time indicators of and reasons for fidelity deviations. These methods require further evaluation.Trial registrationISRCTN Registry, ISRCTN38581822 (Registered: 02/01/2014).

Gains in Daily Stepping Activity in People With Chronic Stroke After High-Intensity Gait Training in Variable Contexts.

Many physical therapist interventions provided to individuals with chronic stroke can lead to gains in gait speed or endurance (eg, 6-Minute Walk Test [6MWT]), although changes in objective measures of participation are not often observed. The goal of this study was to determine the influence of different walking interventions on daily stepping (steps per day) and the contributions of demographic, training, and clinical measures to these changes. In this secondary analysis of a randomized clinical trial, steps per day at baseline and changes in steps per day following 1 of 3 locomotor interventions were evaluated in individuals who were ambulatory and >6months after stroke. Data were collected on 58 individuals who received ≤30 sessions of high-intensity training (HIT) in variable contexts (eg, tasks and environments; n = 19), HIT focused on forward walking (n = 19), or low-intensity variable training (n = 20). Primary outcomes were steps per day at baseline, at post-training, and at a 3-month follow-up, and secondary outcomes were gait speed, 6MWT, balance, and balance confidence. Correlation and regression analyses identified demographic and clinical variables associated with steps per day. Gains in steps per day were observed across all groups combined, with no between-group differences; post hoc within-group analyses revealed significant gains only following HIT in variable contexts. Both HIT groups showed gains in endurance (6MWT), with increases in balance confidence only following HIT in variable contexts. Changes in steps per day were associated primarily with gains in 6MWT, with additional associations with baseline 6MWT, lower-extremity Fugl-Meyer scores, and changes in balance confidence. HIT in variable contexts elicited gains in daily stepping, with changes primarily associated with gains in gait endurance. Providing HIT in variable contexts appears to improve measures of participation (eg, daily stepping) that may be associated with clinical measures of function. Gains in multiple measures of mobility and participation with HIT in variable contexts may improve the efficiency and value of physical therapy services.

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model.

The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists’ prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK’s six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists’ broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.

Occupational therapy interventions for adult informal carers and implications for intervention design, delivery and evaluation: A systematic review

Introduction Informal carers provide vital support for patients, reducing strain on health and social care services. However, caring can detrimentally affect carers’ health and wellbeing, thus policy advocates for improved carer support. Objective: to establish the published international evidence base regarding interventions for carers delivered by occupational therapists. Method English language studies published January 2010–January 2021 were identified against predetermined inclusion/exclusion criteria via searches of MEDLINE, EMBASE, CINAHL, PsychINFO, OTSeeker, Scopus, Web of Science and the Cochrane Library. Supplemental strategies: database alerts, hand-searching, searching of included papers’ reference lists and citations, and contacting key authors. Two reviewers completed critical appraisal and produced a textual narrative synthesis of data using a convergent integrated method. Results 38 papers were included, reporting 21 interventions. Most were dyadic, home-based interventions for carers of people living with dementia. Common intervention components included: assessment and goal-setting, skill training, education, coping strategies, equipment provision, environmental adaptation and signposting. Interventions improved outcomes for carers, however, intervention design and evaluation require careful consideration to maximise carer benefits and capture intervention effects. Conclusion Occupational therapist delivered carer interventions enhance support and improve carer outcomes. Intervention and evaluation designs should include careful selection of outcome measures, avoidance of increased carer burden in dyadic interventions and acknowledgement of known barriers and facilitators to both carer and therapist intervention engagement.

Overall Effects and Moderators of Rehabilitation in Patients With Wrist Fracture: A Systematic Review.

Wrist fractures constitute the most frequently occurring upper limb fracture. Many individuals report persistent pain and functional limitations up to 18months following wrist fracture. Identifying which individuals are likely to gain the greatest benefit from rehabilitative treatment is an important research priority. This systematic review aimed to summarize effectiveness of rehabilitation after wrist fracture for pain and functional outcomes and identify potential effect moderators of rehabilitation. A comprehensive search of 7 databases (including MEDLINE, EMBASE, and the Physiotherapy Evidence Database) was performed for randomized controlled trials involving adults >50years of age who sustained wrist fracture and had received 1 or more conservative treatments (eg, exercise/manual therapy, lifestyle, diet, or other advice). Study selection, data extraction, and risk-of-bias assessment were conducted independently by 2 reviewers. Results of included trials were summarized in a narrative synthesis. A total of 3225 titles were screened, and 21 studies satisfying all eligibility criteria were reviewed. Over one-half of the included studies (n = 12) comprised physical therapist and/or occupational therapist interventions. Rehabilitative exercise/manual therapy was generally found to improve function and reduce pain up to 1year after wrist fracture. However, effects were small, and home exercises were found to be comparable with physical therapist-led exercise therapy. Evidence for the effects of other nonexercised therapy (including electrotherapy, whirlpool) was equivocal and limited to the short term (<3months). Only 2 studies explored potential moderators, and they did not show evidence of moderation by age, sex, or patient attitude of the effects of rehabilitation. Effectiveness of current rehabilitation protocols after wrist fracture is limited, and evidence for effect moderators is lacking. Currently available trials are not large enough to produce data on subgroup effects with sufficient precision. To aid clinical practice and optimize effects of rehabilitation after wrist fracture, potential moderators need to be investigated in large trials or meta-analyses using individual participant data. Many patients report persistent pain and functional limitations up to 18months following wrist fracture. Effectiveness of current rehabilitation protocols after wrist fracture is limited and may be due to insufficient targeting of specific rehabilitation to individuals who are likely to benefit most. However, evidence for effect moderators is lacking within the currently available literature. To aid clinical practice and optimize effects of rehabilitation, investigating potential moderators of rehabilitation in individuals with wrist fracture via large trials or meta-analysis of individual participant data is research and policy imperative.

Rehabilitation in dementia: CST and Sonas group interventions for people with moderate cognitive impairment. A pilot study

Purpose Dementia is a complex, progressively degenerative condition. It results in loss of cognitive and functional capabilities, along with a significant increase in the level of dependency. A reduction in the use of pharmacological interventions correlates with an increased in good quality non-pharmacological interventions in dementia care. The purpose of this study is to examine the impact of 14-session face-to-face cognitive stimulation therapy (CST) and Sonas group interventions on individuals living with dementia with moderate cognitive impairment, from pre-intervention to post-intervention in terms of their cognition, communication, neuropsychiatric symptoms, activities of daily living and quality of life. Design/methodology/approach A pilot single blind prospective controlled trial evaluated two group intervention approaches, cognitive stimulation therapy (CST) and Sonas, with 28 participants with moderate dementia. Pseudorandomisation and single blinding were implemented. CST has a solid evidence base. Sonas is a widely used multi-sensory intervention in Ireland with an emerging evidence base. Participants were recruited from a mental health service. Participants who had a formal diagnosis of dementia, moderate cognitive impairment and some ability to communicate and understand communication were included. Findings Results supported CST to a greater extent than Sonas. The CST group showed significant changes in cognition (p = 0.032) and communication (p = 0.006). Both groups had significant changes in carer quality of life (CST, p = 0.019; Sonas, p = 0.035). Results support the recommendations for a future definitive trial. Research limitations/implications Rehabilitation potential of individuals living with moderate dementia was demonstrated. This study suggests that group interventions like these impact on the trajectory of dementia. Practical implications Rehabilitation interventions impact on the trajectory of dementia. CST and Sonas have no impact on activities of daily living. Future studies with larger sample sizes, 16 weeks intervention period and control groups are required. Social implications This pilot study supports CST over Sonas interventions for individuals living with moderate dementia. Multiple outcome measures demonstrated trends towards significance for both interventions. Future definitive trials may detect a significant effect of both interventions. Originality/value A dementia diagnosis is devastating and generally creates negative perceptions and associations (Alvira, 2014). In contrast, the outcomes of this study are positive. This study provides evidence that occupational therapist intervention can impact on the trajectory of the condition with people with dementia demonstrating that they do have rehabilitation potential by responding to treatment and improving and maintaining their abilities as they progress through the condition.

Efficiency and usability of a modified pegboard incorporating computerized technology for upper limb rehabilitation in patients with stroke

ABSTRACT Background Traditionally, a pegboard has been commonly used as a useful training and assessment tool for patients with stroke. However, training using pegboards could be monotonous and may discourage motivation in patients with stroke, as it requires only repetitive movements without feedback. Objectives We aimed to demonstrate the efficiency and usability of a novel rehabilitation instrument (Rapael Smart Pegboard; SP), which integrates computerized technology into a traditional pegboard. Methods This single-center study with a single-group pre–post design included 19 patients with hemiplegic stroke (11 outpatients and 8 inpatients). The patients received 20 SP training sessions (30 minutes per session, 5 days per week, over 4 weeks) according to their ability and status without any therapist intervention. The primary outcome was changes in the Fugl–Meyer assessment of upper extremity (FMA), and the secondary outcomes were changes in the Box and Block test and Jebsen–Taylor Hand Function test (JHFT). Additionally, usability assessment was performed. Results All outcome measurements except JHFT-gross score showed significant improvements with SP training. The significant improvements in these outcomes were consistently found in the outpatient group; however, the inpatient group failed to show improvement in the distal part of FMA, total JHFT score, and time. The usability test showed high satisfaction with 4.9 out of 5 points. Conclusions The SP is an effective and feasible instrument for upper limb rehabilitation. Moreover, the SP can be used as a self-training tool without the assistance of a health care practitioner.

Continuing Education Courses for Orthopedic and Sports Physical Therapists in the United States Often Lack Supporting Evidence: A Review of Available Intervention Courses.

The purpose of this study was to characterize the extent to which orthopedic and sports-related continuing education course descriptions approved for physical therapists in the United States taught interventions supported by evidence. A review was conducted of courses available on CEU Locker from January through December 2020, estimated to represent most courses nationally available to physical therapists. This review focused specifically on courses teaching interventions for musculoskeletal conditions in adults. Specifically, courses for orthopedic and sports populations were identified. All course information was extracted, including the intervention name, course description, and target audience. Finally, clinical practice guidelines (CPGs) and systematic reviews with at least moderate-level evidence published through May 1, 2021, were searched to determine if treatments were recommended or not recommended, or if no evidence existed. The review identified 2406 available courses extracted from the database. After excluding courses that did not meet inclusion criteria, duplicates, and those with incomplete or inadequate information, the final number was 319. Most courses (52.7%, n = 168) taught interventions not supported by a CPG or systematic review. Approximately one-third of courses (34.2%, n = 109) taught interventions that were recommended by a CPG. Many courses were targeted to multiple disciplines (38.9%, n = 124), whereas 89 (27.9%) were specifically for physical therapists, physical therapist assistants, or both. The specific target was unclear for 106 (33.2%) courses. Courses usually focused on multiple body regions, and exercise was the most included intervention. Soft-skill courses were the most supported by evidence (82.9%, n = 29), whereas those teaching modalities were the least supported (30.5%, n = 29). Fewer than one-half of courses that focused on management of musculoskeletal disorders taught interventions supported by a CPG or systematic review, and course descriptions often misrepresented the current state of evidence. Courses required for licensure renewal might not be meeting the intended goal of keeping clinicians current with new and emerging research. Relatively few continuing education courses on orthopedic and sports-related physical therapist interventions are based on evidence provided by CPGs or systematic reviews, and some continuing education options required for physical therapists to meet annual licensure renewal requirements might not be keeping therapists current with the latest evidence. This study provides data that can facilitate candid dialog within the profession about potential solutions.

Primary Care Physical Therapists' Experiences When Screening for Serious Pathologies Among Their Patients: A Qualitative Study.

ObjectiveA vital part of the initial examination performed by a physical therapist is to establish whether the patient would benefit from physical therapist intervention. This process includes knowledge about contraindications for treatment and screening for serious pathologies. However, little is known about the physical therapists' views and thoughts about their own practice when screening for serious pathologies. The purpose of this study was to explore the experience gained by physical therapists when screening for serious pathologies among their patients.MethodsThis was a qualitative study based on individual semi-structured interviews with 9 primary care physical therapists. The interviews were analyzed using reflexive thematic analysis, and generated themes were explained and reported with relevant quotes.ResultsThree overall themes were generated: (1) the role of physical therapists in the diagnostic process; (2) responsibility from the individual to the group; and (3) the difficult task of cooperation. The physical therapists described how they relied more on their clinical suspicion than on asking red-flag questions when screening for serious pathologies. They also questioned their differential diagnostic abilities. Finally, they saw a potential to further enhance their confidence in the area by reflecting on the matter with colleagues and by receiving more feedback about their clinical reasoning regarding serious pathologies from general practitioners.ConclusionThese findings suggest that physical therapists primarily rely on their clinical suspicion when screening for serious pathologies but at the same time are uncertain about their differential diagnostic abilities.ImpactThese findings can inform future interventions targeting the physical therapists' abilities to detect serious pathology.

Somatic Interventions and Depth of Experiencing in Emotionally Focused Couple Therapy

ABSTRACT Emotionally Focused Couple Therapy (EFT), an attachment-based couple therapy, views emotion as being central to the process of therapeutic change. As affect arousal of emotion is a somatic reaction, the purpose of this study was to focus on therapists’ interventions classified as noting and commenting on clients’ somatic cue of emotional experience, such as their facial expression or posture, in relation to depth of emotional experiencing demonstrated by clients in EFT couple therapy sessions. The sample included 13 therapists, each treating one couple during a single EFT training demonstration session. We coded therapists’ interventions (i.e., commenting on one partner’s somatic cue of emotion). Immediately prior to and following such therapist interventions, we rated the partner’s depth of emotional experiencing. The results of multilevel modeling demonstrated a significant linear increase in terms of depth of partner’s experiencing throughout the session. Furthermore, partners demonstrated a significant immediate increase in the depth of experiencing following somatically focused interventions. These findings suggest that interventions focusing on somatic experience of emotion may facilitate deeper experiencing for clients in EFT sessions.