Therapist Practice Research Articles

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.

Student Experiences of a Home-Based Acute Care Curriculum

Background/Purpose: The COVID-19 pandemic disrupted physical therapy education beginning in March 2020. Acute care physical therapy is complex and has substantive psychomotor skills and safety demands. Students can experience significant challenges during acute care clinical education experiences (CEE); therefore, assessment of the effect of curricular adjustments on preparation for clinical experiences is paramount. Students can experience significant challenges during acute care CEE. Educational programs continue to assess the effect of pandemic dictated altered modes of delivery of laboratory-based courses on student outcomes. The purpose of this qualitative case report is to explore students' experiences of an online delivery mode of an acute care course and their perception of its ability to prepare the student for an acute care CEE. Case Description: Interviews were completed with physical therapist students after their terminal acute care CEE. Qualitative analysis was approached from an interpretive epistemological perspective and a phenomenological approach was used to explore students' experience in participating in an online delivery mode to gain the required skills to be effective during acute care physical therapist practice. Data analysis was completed using a thematic analysis approach. Outcomes: Seven students participated in qualitative interviews after their acute care educational experience. Qualitative results revealed 3 main themes: (1) Course Design, (2) Fidelity, and (3) Learner Characteristics as contributors to feelings of preparedness when transitioning from the classroom to an acute care CEE. Discussion and Conclusion: Despite COVID-19 disruptions to traditional in-person education delivery of an acute care laboratory-based course, a unique at-home delivery of acute care curriculum led to students reporting sufficient skill development to participate in an acute care CEE. Aspects of the unique course that students reported facilitated their learning were skill repetition and fidelity to clinical practice embedded in laboratory activities. Results can be used to intentionally design coursework to aide in building student confidence and preparation for acute care CEE.

Impact of COVID-19 on clinical practice of UK-based speech and language therapists working with school-aged children with neurodisability and oropharyngeal dysphagia: A survey.

The COVID-19 pandemic and response changed clinical service delivery and practice for speech and language therapists (SLTs) in the United Kingdom. SLTs work with children with neurodisability regarding both difficulties with their communication and eating and drinking skills (oropharyngeal dysphagia). This survey aimed to specifically explore the impact of the COVID-19 pandemic on SLT practice for school-aged children with dysphagia. UK-based SLTs working with school-aged children with neurodisability and oropharyngeal dysphagia were recruited to share their perceptions on the impact of COVID-19 on practice. Four questions focusing on COVID-19 impact were part of a larger online survey exploring SLT clinical practice regarding mealtime management of children with neurodisability and oropharyngeal dysphagia, which included demographic information, service delivery, assessment and intervention practices. COVID-19 impact questions were a mixture of multiple choice and free text responses. The survey was disseminated using professional networks and social media, between 14 May and 30 July 2021. Data were analysed using descriptive statistics and qualitative content analysis. One hundred and two participants answered at least one of the four COVID-19 questions. Eighty-two per cent of SLTs either agreed or strongly agreed that COVID-19 impacted on service delivery to children and families. Negative impacts on service delivery included school absences/closures, home visiting restrictions, families declining input and/or having barriers to telehealth use and the impact of mask wearing on interactions. Positive impacts included increased telehealth access and skills, increased contact with families and focus on children's eating and drinking function within the home environment. Participants aimed to maintain the increased contact with families alongside a hybrid service delivery approach of in-person and virtual appointments. This survey provides novel information capturing SLT practice change across two waves of COVID-19 and return to in-person practice for UK children with neurodisability.

A survey of therapists’ experience of ending therapy with people with intellectual disabilities

PurposeA range of adaptations and therapy processes have been explored in relation to therapy with people with intellectual disabilities; however, there remain a few areas of therapy practice that have not yet been considered in depth. This study aims to report the results of an online survey of the practice of therapists working with people with intellectual disabilities in managing endings in therapy.Design/methodology/approachThirty-one therapists working with people with intellectual disabilities responded to an online survey. The data were analysed using reflexive thematic analysis.FindingsThree superordinate themes were identified: Theme 1 was “preparing for a therapeutic ending” with subordinate themes of “planning early”, “providing boundaries” and “validating feelings”; Theme 2 was “providing a therapeutic ending”, with subordinate themes of “a collaborative decision” and “fostering growth”; and the third theme was “post-ending issues” in which participants acknowledged a “spectrum of emotion”, and, in the case of difficult endings, a sense of “unfinished business”.Originality/valueThis is the first systematic exploration of therapy endings as described by therapists working with people with intellectual disabilities. The authors discuss implications for practice and further areas of research.

Assessment of sensory impairment of the upper limb post-stroke by occupational therapists within the acute setting: A mixed methods study exploring current clinical practice

Introduction: Sensory impairment of the upper limb is common after stroke and negatively impacts a stroke survivor’s recovery. The acute phase is a critical time for the identification of post-stroke somatosensory impairments and occupational therapists have a key role in the acute stroke setting. Sensory assessment and treatment practices of occupational therapists working in acute stroke settings are largely unknown. This study aims to describe current clinical practice and identify the barriers and enablers for the assessment of sensory impairment in patients post stroke within acute stroke units. Method: A mixed-methods approach was utilised, with an Australian national cross-sectional online survey of occupational therapists ( n = 85) and state-based focus groups ( n = 2). Descriptive analyses and thematic analysis were conducted. Findings: The majority of clinicians (78%) use non-standardised measures to assess for somatosensory impairment. Three qualitative themes were identified: acute setting contextual factors, individual patient characteristics and priorities, and clinician knowledge and perceived benefits. Conclusion: Occupational therapists working within acute stroke units are aware of the importance of assessing sensory impairment of the upper limb post stroke. However, the majority use non-standardised approaches and called for a standardised quick-to-administer tool kit that is readily available in acute stroke units.

WEB APPLICATION METHOD "3D EMOTION COMPOSITION IN SUPERVISION" APPROBATION

The global pandemic has accelerated the development of the digital environment, face-to-face work is transferred online, so it is important to create tools adapted to the digital environment. The emergency of Covid-19 has raised the demand for online supervision. In supervision sessions, it is important to talk about experiencing emotions in a professional environment. Latvia lacks digital methods for working with emotions in supervision. The aim of the study was to adapt the 3DEC method, to create it as a web application for use in remote supervision and to approbate the web application "3D emotion composition in supervision" in individual online supervisions. The original method 3DEC is intended for the evaluation of emotional experience in the practice of art therapists (Lejstrauta, 2021; Vanadziņa, 2021). The theoretical basis of the 3DEC method is integrative and includes the following principles: visual representation of emotions in a visible symbolic form; play and play space (Winnicot, 2007); distancing as one of the cognitive emotion regulation strategies (Powers LaBar, 2019). 3DEC is also based on the Adaptive Coping with Emotions Model (ACE Model) (Berking Whitley, 2014). The adapted method “3D composition of emotions in supervision” (3DECS) is intended for work in online supervision with the aim to promote awareness of emotions, their understanding and self–reflection. Using distancing and view of other perspectives, the method helps the client to reflect and become aware of emotional experiences, as well as provides an educational function about the meaning of emotions. The 3DECS method develops emotional awareness and adaptive emotion regulation skills. Main results: 1) the web application has been tested and is designed to work with emotions in supervision; 2) the data of the approbation stage show that the web application is sufficiently simple and intuitive; 3) the web application is secure because no information about the customer and the customer's actions in the tool is stored; 4) there are no restrictions on the use of the web application in relation to the duration of the cooperation between the supervisor and the supervision client.

Telehealth as a New Model of Healthcare Delivery for Physical Therapist Practice in Saudi Arabia: A Cross-Sectional Study

Background: Following the coronavirus disease 2019 (COVID-19) outbreak, there were considerable changes in healthcare delivery worldwide. A shift to remote healthcare delivery modalities was necessary due to the lockdown and related social distance requirements. However, the current and future use of telehealth will rapidly increase. Objectives: This study aimed to evaluate the use, attitude and willingness, experience and confidence, and barriers to delivering healthcare via telehealth services among physical therapists (PTs) in Saudi Arabia. Methods: A cross-sectional questionnaire was distributed to PTs. The questionnaire included items on demographic data, telehealth uses, experience and confidence, and attitudes and expectations. Descriptive statistics were used for the participants’ demographic data and responses. Results: A total of 372 participants with an average age of 29 ± 5.5 years were enrolled in the study. Only 143 participants (38.4%) provided telehealth services, and the majority (n = 121; 84.6%) used telehealth during the COVID-19 pandemic. Overall, the majority of the PTs had not received training in telehealth (n = 231; 62.1%). The most commonly rated platform used in telehealth for consultation was Zoom (38.1%). The participants (n = 224; 60.2%) believe that telehealth is an important and useful tool in physical therapy practice. Furthermore, the PTs showed a desire to learn more about telehealth practices (n = 266; 71.5%). They confirmed that they would like to use telehealth in the future (n = 211; 56.7%). Conclusions: The PTs showed a good experience with and use of telehealth. However, there is a need for training courses in this regard. These positive findings make telehealth practice feasible and acceptable in healthcare services in physical therapy interventions.

Developing a Program forAdvanced Physical Therapist Practice inAmputation Care.

Over the past 20 years, military medicine made greatstrides in the medical management of traumatically injured patients. Significant advancements were made in the treatment and rehabilitation after limb loss. These advancements can be attributed to the large number of complex patients presenting to military treatment facilities and the demand for medical professionals to provide care to patients with complex injuries and multiple traumatic amputations. The concern now is to maintain the skills needed to be prepared for the next conflict. To meet this demand, the Extremity Trauma and Amputation Center of Excellence (EACE) initiated the documentation of knowledge, skills, and abilities (KSAs) to ensure that the skill sets needed to treat this unique population are not lost. The EACE developed KSAs to sustain advanced clinical practice for physical therapists, occupational therapists, and prosthetists and is in the process of developing KSAs for orthotists and physical medicine physicians. The learning objectives [terminal and enabling learning objectives (TLOs and ELOs)] derived from each set of KSAs will drive curricula development for enduring education, residencies, and fellowships. This article describes the KSAs and learning objectives for advanced physical therapist competencies in amputation care. Clinical subject matter experts (SMEs) convened from the Department of Defense (DoD) Advanced Rehabilitation Centers (ARCs) to draft the initial KSAs. All experts had specific expertise in treating individuals with highly complex lower and upper limb amputation. In a quasi-Delphi methodology, the initial draft KSAs underwent five cycles of review and comment by an additional 15 DoD, Veterans Affairs, and civilian institution experts from clinical practice, education, and research. The consensus KSAs were then transcribed into learning objectives with collaboration between clinical subject matter experts and doctoral-level educators. The final program document has 21 instructional modules with 30 TLOs and 157 ELOs. The KSAs and the learning objectives describe the skills expected of an advanced practice physical therapist treating patients with traumatic limb loss. Weaknesses of this document include the focus on traumatic amputation and military specific needs. However, many of the central advanced practices are universal to all physical therapists working in amputation. Thus, this document should serve as a starting point and can evolve to include dysvascular, oncology, and other etiologies. To our knowledge, this is the first paper to describe the KSAs for the advanced practice physical therapist working with traumatic limb loss population. This work will form the framework for physical therapist advanced practice training programs.

Training the ageing bodies: New knowledge paradigms and professional practices in elderly care.

In the Scandinavian countries, reablement has become a principle permeating all parts of elderly care, hence potentially transforming care and care work. This article explores the advent of new knowledge paradigms and practices of physiotherapists and occupational therapists transforming reabling care in particular ways, leading to what we term a logic of training emerging in the field. These professional groups have obtained a dominant position as reablement specialists in Norway and Denmark, where our extensive fieldwork was performed as part of a 3-year research project. Taking inspiration from Annemarie Mol's concept of logic, we study how professional practices are organised and infused with specific values, meanings and ideals in situated contexts. We hence explore the logic of training, its abstracted image of the body and rational goal-oriented model for progress measurement and its ramifications when addressing ageing bodies in a complex field marked by the unpredictabilities of the social and lived bodies, administrative rules and temporalities and the quest for empowering and involving clients. The paper concludes by pointing at new contradictions arising when practicing reabling care and particularly points out the tensions arising in care relations, where ambitions on empowering and disciplining the client and the elderly body may collide.

A Comprehensive Review of the Mechanisms of NMT For Reversing Neurodegenerative Disorders

This paper reviews the literature concerning the mechanisms of music therapy that improve the quality of life for patients with neurodegenerative diseases. Music therapy is a remedial practice involving music to help improve health. Certain professional therapists practice Neurologic Music Therapy (NMT) as an allied health profession that provides evidence-based care to hospitalized patients, not just as a source of comfort, but also as a source of healing. This is especially the case for patients with neurodegenerative disorders such as Alzheimer's disease, Parkinson’s disease, and expressive aphasia. The current growing body of researchers is investigating the effects of music therapy on memory, speech, motor control, and behavior. However, various questions remain unanswered. In this review paper, we gathered primary literature to evaluate the use of music therapy and the mechanisms that lead to successful outcomes. Music therapy is important because it provides a way to enhance comfort for diseased patients, whether in a hospitalized state or an average daily scenario. In patients with neurodegenerative diseases, music increases plasticity in areas of the brain that may improve speech, memory, behavior, and more. As we better understand the mechanisms and optimize music therapy, it may provide more ease to patients and even treat and cure certain disorders in the future.

Social Power and the Movement System: Why and How Physical Therapists Might Influence the Upstream Currents of Health.

Social determinants of health are an emerging focus within physical therapist practice, research, education, and advocacy as a necessary condition for movement system health disparities. Fundamental cause theory suggests that the sociopolitical environment sets the context for individuals' socioeconomic positioning, which determines the availability of resources that are necessary for groups and individuals to maintain health. These resources include knowledge, money, power, prestige, and social connections. Yet, it is the hierarchical organization of society that dictates both the availability of socioeconomic resources and the ability of patients and clients to use those resources to promote and maintain movement system health. The presence of social hierarchies indicates the need for physical therapists to consider social power as a key determinant of movement system health. Consideration of social power in clinical initiatives and advocacy agendas would provide a framework for physical therapists to begin the dynamic, and often, adversarial process of breaking down social hierarchies and redistributing social power, rather than simply redistributing socioeconomic resources, in pursuit of societal transformation and community-building. This Perspective discusses social power as the fundamental driver of movement system health inequalities and explores the effects of social power on exposure, susceptibility, experience, and recovery related to movement system pathology-including the influence of social power on the ability of people to acquire socioeconomic resources and convert them to health-relevant resources. This perspective concludes with recommendations for physical therapists to identify and dismantle inequalities in social power through structural competency.

Picky eating in children: Current clinical trends, practices, and observations within the Australian health-care context.

Childhood picky eating occurs when there is limited intake or variety of food and/or unwillingness to try new foods. Within research settings, standardised assessments are used to describe picky eating behaviours in children. However, little is known about assessment practices of occupational therapists. Similarly, occupational therapy interventions for picky eating in the literature focus on; providing strategies for parents, and working with the child on self-feeding skills. Despite this, interventions and strategies utilised by occupational therapists in clinical practice within an Australian health-care context are unknown. This study examines Australian health professionals' observations of picky eating behaviours, the use of childhood picky eating assessments and interventions, and differences between occupational therapists and other professionals. Health professionals (n= 179) were recruited through professional organisations, such as Occupational Therapy Australia. Participants completed an online survey between March and May 2021. Independent variables were reported using descriptive statistics, with logistic regression used to consider differences between occupational therapists and other health professionals. Conventional content analysis was used to analyse responses to open-ended questions. The final sample included 109 eligible participants, with an average of 8.5 years working with picky eaters. Results indicated picky eating behaviours aligned with those reported in the literature. Participants relied on clinical observations and workplace designed assessments. The most common interventions were education, coaching, and the sequential oral sensory approach to feeding. Occupational therapy participants were significantly more likely than other health professional participants to report always using coaching and education. Although few health professionals used standardised or validated assessments, the use of education and coaching by occupational therapists aligned with the literature. Results highlight the need for more rigorous investigation to determine the sensitivity of current assessments to differentiate between clinical and typical picky eating, and the effectiveness of interventions for childhood picky eating.

Current Practice of Physical Therapists: An evidence-based practice survey

Background: Patient/client management is comprehensive multidirectional process. It includes patient client examination, evaluation, diagnosis, prognosis, intervention and then discharge plans from supervised treatment to follow ups. The process of examination includes comprehensive history taking, performing systemic review and special tests and measures. Aim: To investigate Pakistani physiotherapists’ current practice, skills and understanding of evidence-based practice in order to improve the utilization of the evidence base in physiotherapy in the country. Methods: This observational cross section study was done in Pakistan Institute of Medical Sciences and Islamabad Medical and Dental College, Islamabad between January 2021 and March 2021. Physiotherapists(n=369) were contacted through non-probability convenience sampling technique. Respondents were contacted at clinical facilities in the twin cities of Pakistan. The content of the questionnaire was validated using the literature and the method of Lynn MR et al. The results were extracted, conclusion was drawn, suggestions and recommendations were made. Results: The participants mean age was 27.58±7.41 years. The male/female ratio was almost same. Approximately half of the respondents 50.4% were agreed about the role of EBP in practice.57% respondents were agreed that EBP removes the art from clinical practice. 58.5% respondents were agreed about benefit of EBP and EBP improves clinical outcomes and 53.4%respondents were agreed about help of EBP in decision making. Attitude and knowledge need analysis was positive but there found compromise in utilization of this evidence-based practice, while this study showed more utilization. Conclusion: Five steps of evidence-based practice were found being infrequently practiced. Physiotherapists had good to fair understanding of evidence-based practice. Physiotherapists had fair to poor appraisal skills. Keywords: Clinician practice; Data base; Evidence-based practice; Physical therapist; Practice guideline; Patient management.

UK speech and language therapists' assessment of children's expressive language, and functional impairment and impact, following the CATALISE publications.

In 2016/17, the CATALISE Consortium published the results of a multinational and multidisciplinary Delphi consensus study, representing agreement among professionals about the definition and process of identification of children with Developmental Language Disorder (DLD) (Bishop etal., 2016, 2017). The extent to which the current clinical practice of UK speech and language therapists (SLTs) reflects the CATALISE consensus statements is unknown. To investigate how UK SLTs' expressive language assessment practices reflect the CATALISE documents' emphasis on the functional impairment and impact caused by DLD, by examining: whether multiple sources of assessment information are gathered; how standardised and non-standardised sources are combined in clinical decision-making, and how clinical observation and language sample analysis are utilised. An anonymous, online survey was carried out between August 2019 and January 2020. It was open to UK-based paediatric SLTs who assess children up to age 12 with unexplained difficulties using language. Questions probed different aspects of expressive language assessment which are referred to in the CATALISE consensus statements and supplementary comments, and asked about participants' familiarity with the CATALISE statements. Responses were analysed using simple descriptive statistics and content analysis. The questionnaire was completed by 104 participants, from all four regions of the United Kingdom, working in a range of clinical settings with different levels of professional experience of DLD. The findings indicate that clinical assessment practices broadly align with the CATALISE statements. Although clinicians carry out standardised assessments more frequently than other types of assessment, they also gather information from other sources and use this alongside standardised test scores to inform clinical decisions. Clinical observation and language sample analysis are commonly utilised to evaluate functional impairment and impact, along with parent/carer/teacher and child report. However, asking about the child's own perspective could be more widely utilised. The findings also highlight a lack of familiarity with the details of the CATALISE documents among two thirds of the participants. Assessment practices broadly align with the CATALISE statements, but there is a need for greater clarity regarding terminology and the assessment of functional language impairment and impact. This research should prompt discussion in the profession about how to further develop and adopt expressive language assessment practices which reflect the CATALISE consensus and support effective assessment. What is already known on the subject The CATALISE consortium documents on Developmental Language Disorder (DLD) were published in 2016/17. The extent to which expressive language assessment practice in the United Kingdom reflects the new definition and statements on assessment has not previously been investigated. What this paper adds to existing knowledge This survey indicates that speech and language therapists in the United Kingdom assessing children for DLD mostly balance standardised language test scores with other sources of information in clinical decision-making, and utilise clinical observation and language sample analysis to consider functional impairment and the impact of the language disorder. However, important questions are raised regarding the robustness and objectivity with which these key parameters are currently defined and evaluated. What are the potential or actual clinical implications of this work? Clinicians, individually and at service level, are encouraged to reflect on their assessment of functional impairment and the impact of language disorder and to take steps to incorporate this where necessary. Professional guidance and clinical tools to facilitate robust, objective assessment would support clinical practice that aligns with expert consensus.

New Graduate Respiratory Therapists' Perceptions of Their Transition to Practice.

The emerging challenges in the healthcare system require a vision for the future of respiratory care to ensure a successful transition to practice for new graduate respiratory therapists (RT). The nursing profession has recognized the need to acknowledge the successes and failures of graduates' transition to practice so that these programs can be continuously improved. The challenge is in identifying aspects of the transition to practice that may improve job satisfaction, retention, professional development, and patient care for RTs. This research aimed to explore the perceptions of new graduate RTs' experiences during their first year of practice and identify barriers and facilitators to a successful transition to practice. This qualitative descriptive study surveyed new graduate RTs who transitioned to practice from May 2019 to December 2021 at a New England academic medical center respiratory care department. Twenty-eight new graduate RTs responses were included in the study. The majority of the respondents experienced a successful transition to practice; however, they faced many barriers. New graduate RTs reported that their orientation did not provide enough experience and exposure to gain confidence in critical skills and procedures. They also experienced stress due to COVID-19 and interpersonal relationships, felt overwhelmed by their workload, and were subject to negative workplace behavior. New graduate RTs experienced many barriers to their transition to practice. Respiratory care leadership should identify barriers faced by new graduate RTs during their transition to practice. A nurse residency model may provide a framework for RT transition-to-practice programs. Improving transition-to-practice programs for new graduate RTs and surveying their experiences may lead to an increase in job satisfaction, retention, and improved patient care.

Exploring if and how evidence-based practice of occupational and physical therapists evolves over time: A longitudinal mixed methods national study.

Occupational therapists (OTs) and physiotherapists (PTs) are expected to provide evidence-based services to individuals living with disabilities. Despite the emphasis on evidence-based practice (EBP) by professional entry-level programs and professional bodies, little is known about their EBP competencies upon entry to practice and over time or what factors impact EBP use. The aim of the study was to measure and understand how EBP evolves over the first three years after graduation among Canadian OTs and PTs, and how individual and organizational factors impact the continuous use of EBP. A longitudinal, mixed methods sequential explanatory study. We administered a survey questionnaire measuring six EBP constructs (knowledge, attitudes, confidence, resources, use of EBP and evidence-based activities) annually, followed by focus group discussions with a subset of survey participants. We performed group-based trajectory modeling to identify trajectories of EBP over time, and a content analysis of qualitative data guided by the Theoretical Domains Framework. Of 1700 graduates in 2016-2017, 257 (response rate = 15%) responded at baseline (T0) (i.e., at graduation), and 83 (retention rate = 32%), 75 (retention rate = 29%), and 74 (retention rate = 29%) participated at time point 1 (T1: one year into practice), time point 2 (T2: two years into practice, and time point 3 (T3: three years into practice) respectively. Group-based trajectory modeling showed four unique group trajectories for the use of EBP. Over 64% of participants (two trajectories) showed a decline in the use of EBP over time. Fifteen practitioners (7 OTs and 8 PTs) participated in the focus group discussions. Personal and peer experiences, client needs and expectations, and availability of resources were perceived to influence EBP the most. Though a decline in EBP may be concerning, it is unclear if this decline is clinically meaningful and whether professional expertise can offset such declines. Stakeholder-concerted efforts towards the common goal of promoting EBP in education, practice and policy are needed.

Comparison Between Neuroscience- and DIRFloortime®-Informed Approaches Within Music Therapy: A Descriptive Case Study

Abstract Music therapists practice from different clinical approaches; however, these approaches have not been compared in a research study. The purpose of this descriptive case study was to examine differences in behaviors for one participant on the autism spectrum and their therapist practicing from two different clinical approaches. We examined five videos where treatment was delivered in a neuroscience-informed approach and five videos in a DIRFloortime®-informed approach. We used observational behavioral coding for three nonmusical social skill behaviors, three musical social skill behaviors, and four therapist behaviors. We also examined the presence of critical elements of each approach within the videos. Results indicated that the therapist overall showed the critical elements for each approach within the examined videos. Targeted participant social behaviors were present in each of the approaches; however, the manner in which they were facilitated was different. Descriptive statistics and visual analysis were used to show similarities and differences between the approaches. Further studies are needed to explore different approaches in music therapy clinical practice.

Clinical practices, challenges, and job satisfaction of occupational therapists working in Community Mental Health Centers in Turkey

Introduction: Occupational therapists have been involved in Community Mental Health Centers (CMHCs) since 2016 in Turkey. To the best of our knowledge, no data about occupational therapists’ practices in CMHCs is available in the extant research literature. Therefore, this study aimed to investigate the clinical practices, challenges, and job satisfaction of occupational therapists working for CMHCs in Turkey. Method: We conducted a cross-sectional survey study in which 28 volunteer occupational therapists working in CMHCs participated. The participants filled out the Sociodemographic and Professional Experience Information Form and the Job Satisfaction Scale. Results: Occupational therapists were experienced practitioners implementing various occupational therapist practices in community mental health and they were generally satisfied with their job. The challenges facing Occupational therapists were communicating with caregivers, motivating the client, enabling the client to perform occupational participation. Collaborative teamwork and participation in training about community mental health were found as the important factors contributing to occupational therapist professionals’ job satisfaction. Conclusion: Investigating the professional behaviors of Occupational therapists, an emerging health profession in Turkey, is important for the development of the profession. The education and supervision specially adapted for community mental health and the supportive teamwork seem to be significant for the job satisfaction of community mental health Occupational therapists.

Referral Decision-Making and Care Continuity in Physical Therapist Practice.

Efficient referral pathways have held promise in improving clinical outcomes, raising patient satisfaction, and reducing costs. Referral decision-making presents a distinct challenge because it requires the consideration of such variables as technology, health-care systems, and local resources. However, best practices for generating a high-value referral and improving care continuity are rarely discussed in the context of physical therapist practice. With physical therapists in some states obtaining explicit imaging privileges and a renewed focus on the physical therapist's role in primary care and patient management over the lifespan, it is time to focus on this underappreciated area of practice. This perspective discusses referral decision-making and provides recommendations for making a high-value referral and improving care continuity. Improving referral and care continuity has potential to enhance clinical outcomes and patient satisfaction and to reduce costs. This perspective explicitly defines and describes strategies to improve physical therapist decision-making about referral and care continuity to improve overall patient management.

How are hamstring strain injuries managed in elite men's football clubs? A survey with 62 Brazilian physical therapists

ObjectiveTo describe perceptions and practices of physical therapists from elite men's football clubs on the management of athletes with hamstring strain injury (HSI). DesignCross-sectional study. SettingOnline survey. ParticipantsPhysical therapists from clubs engaged in the two main divisions of Brazilian men's football. Main outcome measuresPractices for assessment and rehabilitation of athletes with HSI. ResultsThis survey had 62 physical therapists from 35 of the 40 eligible clubs (87.5% representativeness). Despite heterogeneity on assessment practices, all respondents use imaging exams, adopt injury classification scales, and evaluate aspects related to pain, range of motion, muscle strength, and functional status of athletes with HSI. Rehabilitation programs are usually divided into 3 to 4 phases. All respondents usually apply electrophysical agents and stretching in HSI rehabilitation programs, 98.4% apply strengthening exercises (93.5% include eccentrics), 96.8% manual therapy, 95.2% exercises that mimic the functional demands of football, and 93.5% lumbopelvic stabilization exercises. Muscle strength was the most reported return to play criterion (71% of respondents). ConclusionThe present study allowed the sports physical therapy community to become aware of the approaches usually adopted for management of athletes with HSI who play in the highest level of Brazilian men's football.