School-based Physical Therapists Research Articles

Delivery of School-based Physical Therapy via Telehealth: Perceptions and Attitudes of School-based Physical Therapists

Aims School-based physical therapists (SBPTs) rapidly transitioned to telehealth during the pandemic. This study explored the perceptions of, and strategies utilized by, SBPTs delivering therapy via telehealth. Methods Using a grounded theory qualitative design, semi-structured interviews were completed with 13 SBPTs. Interviews were transcribed and theme coded until saturation was achieved. Results The following themes emerged: supports and education, challenges, strategies promoting success, and the outcomes of telehealth. SBPTs overcame challenges including those associated with technology, communication, space, equipment, and examination. Coaching techniques, incorporation into the daily routine, and the sharing of demonstrations promoted success. Telehealth service delivery was perceived to improve communication with educational teams and families, improve efficiency and productivity, increase access to students, promote an appreciation of the family and home context, and enhance family engagement. SBPTs believe incorporating elements of telehealth in conjunction with in-person delivery is ideal. Conclusions While the COVID-19 pandemic forced a rapid transition to telehealth for SBPTs, lessons learned could have a long-lasting positive impact on school-based services. The benefits of telehealth should be considered in the delivery of school-based physical therapy services.

School-Based Physical Therapists’ Perceptions about Becoming Effective Practitioners through Professional Development

Aims The aims of this study were to explore perceptions of school-based physical therapists (SBPTs) about professional development and effective practice and to create a conceptual framework to help understand how SBPTs become effective practitioners who continue to learn and grow professionally as clinicians in an educational setting. Methods Twenty school-based physical therapists completed a demographic questionnaire and a semi-structured interview. Guiding interview questions focused on SBPTs’ perceptions of roles and responsibilities, professional development, barriers, and recommendations. Results Participants identified roles and personal qualities of effective SBPTs. Three concepts for the process of professional development were developed: educational context and culture, barriers to effective practice, and strategies for professional development. Conclusion The development of effective practice for SBPTs is a multifaceted, iterative process involving a unique set of knowledge, skills, and behaviors that allow them to fulfill their roles. The process takes time and effort to understand the self within the educational context and culture, recognize barriers to effective practice, and develop strategies for success. A conceptual framework was developed to assist SBPTs in implementing a plan for professional development that leads to effectively providing services to students and functioning as essential members of the educational team.

Changing the Paradigm of School-Based Physical Therapist Service Delivery: Using Evidence to Support Intensive Intervention.

The purpose of this article is to highlight the paradigm shift away from the typical model of direct service delivery of consistent frequency and duration in the school setting to accommodate an intensive progressive resistive exercise intervention. School-based physical therapists describe how they applied an evidence-based intensive intervention with multiple students in an urban public school district. The school-based physical therapists had to modify the typical service delivery model and overcome other challenges to implement this intensive intervention approach. Substantial improvements in strength and functional activities were observed in multiple students and measured across several months. An intensive intervention model appears effective and feasible in the school setting. Evidence-based intervention approaches should be considered when the student could benefit. For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A339.

Therapists’ Perceptions of Participating in a Large Research Study: Benefits, Challenges, and Impact on Practice

Aims: Clinician participation in research is important to expand clinical research. However, there is limited understanding of the impact of such participation. The purpose of this survey-based study was to describe school-based physical therapists’ perceptions of the impact, benefits, and challenges of research participation. Methods: Participants were school-based physical therapists (n = 67) who had been research personnel in a year-long study. Participants completed a questionnaire regarding their experiences participating in the study. Results: Most therapists (59%) perceived that participating in the study improved their competency as a school-based PT a small extent. Participation impacted some therapists a moderate to a great extent in their student assessments (43%), decision-making (28%), and team collaboration (25%). Almost all therapists (96%) responded that they would participate in research again. Researchers identified three themes regarding benefits of participating in research: 1) research and promoting the growth of the profession, 2) support for and expansion of my school-based practice, and 3) reflective practitioner. Researchers identified four themes regarding challenges of participating in research: 1) administrative aspects; 2) time; 3) training; and 4) implementing the tools. Conclusions: Findings from this study support therapist participation in research, and have implications for clinicians, supervisors, and researchers.

A Critical Examination of School-based Physiotherapists’ Perceived Aptitude and Willingness to Facilitate Health and Wellness Promotion

Placing value on the health and wellness of Children with Disabilities (CWD) should be a core societal value. Twenty percent of children with disabilities aged 10 to 17 are obese. Decreased access to developmentally appropriate recreational activities, and inexperienced instructors lack of knowledge to effectively support their inclusion are barriers to their participation. School-based Physical Therapists (SBPT) are in a distinctive position to provide appropriate and modified fitness programs for children with disabilities. The purpose of this basic qualitative design study was to determine SBPTs’ perspectives on their aptitude and willingness to facilitate fitness, health, and wellness promotion programs for CWD. Social cognitive theory was used as the theoretical grounding for the conceptual framework of this research. The conceptual framework that guided this research was constructed from a combination of the International Classification of Functioning, Disability, and Health for Children and Youth and the Comprehensive School Physical Activity Program conceptual framework. Purposive sampling yielded 12 participants who took part in semi-structured interviews. Data were analyzed through Colaizzi’s seven step method. Results showed that SBPTs felt capable and willing to provide fitness, health, and wellness programs for CWD. Results support findings from the literature that suggest SBPTs are underutilized in the school setting and are equipped to facilitate fitness, health, and wellness initiatives for CWD. Findings inform stakeholders on strategies to steer SBPTs’ role as healthcare professionals in an educational environment. This research brings increased awareness to the potential contribution of SBPTs to partner with schools and families to facilitate fitness, health, and wellness programs for CWD.

Regional Differences in School-Based Physical Therapy: Examination of Therapist and Student Characteristics, Service Delivery, Activities, Interventions, and Outcomes

Aims The aim of this study was to examine regional differences in school-based physical therapy practice focusing on the attributes of the school-based physical therapists and students; service delivery approaches, activities, and interventions; and student outcomes. Recognition of regional practices may decrease unnecessary variations, and assist with therapist clinical decision making and efforts to implement evidence-informed practice. Methods A secondary data analysis of the PT COUNTS data was performed to compare physical therapist and student attributes; service delivery, activities, and interventions; and student outcomes across the Northeast, Southeast, Central, and Northwest regions of the United States. Results Differences in the physical therapist and student characteristics, service delivery, activities, and interventions existed across the regions. There were no regional differences in outcomes when controlling for student functional level. Conclusion Regional differences in school-based practices may be expected and indicative of the influence of contextual factors including state and local policies and procedures that shape school-based service delivery and the characteristics of the therapists and students. Regional differences in practices may not have been of sufficient clinical magnitude to alter outcomes. Physical therapists can use the findings to reflect upon their individual decision making and practices.

Participation-Based Student Goals in School-Based Physical Therapy Practice: Influence on Service Delivery and Outcomes

Aims: Legislation, perspectives, and guidelines support the use of goals that address student participation in school. The purpose of this study was to determine if students with participation-based goals receive school-based physical therapy services differently and demonstrate better outcomes than students with non-participation-based goals. Methods: Secondary data analysis. School-based physical therapists (n = 109) provided services to students (n = 294) over 20 weeks. The physical therapists determined a primary goal for each student and classified this goal based on if it was (n = 181) or was not (n = 113) performed and measured within a school activity or routine (participation-based versus non-participation-based). The physical therapists documented the proportion of services provided within a school activity, on behalf of the student, and consisting of activity-focused functional activities. They also measured goal attainment and assessed participation via the School Function Assessment at the beginning and end of the study. Results: Students with participation-based goals received a significantly greater proportion of services within a school activity than those with non-participation-based goals (p < 0.001). There was no significant difference for the remaining service variables, nor for the outcome variables. Conclusions: Use of participation-based goals may promote school-based physical therapy service delivery within a school activity, thus supporting best practice.

Evidence-Based Secondary Transition Predictors for Physical Therapists Working With High School Students.

Individuals with disabilities experience poorer postschool outcomes compared with their peers without disabilities. Youth with orthopedic or physical disabilities experience challenges during transition particularly in the areas of education and employment. Physical therapists should continue to become more involved in transition planning and providing services for transition-age students with physical disabilities. The purpose of this article is to clarify the role of physical therapists who work with students who have disabilities, as they transition from high school to postsecondary roles as well as provide the current evidence-based predictors of postschool success and recommended practices to school-based physical therapists who work with these students. Evidence-based instructional practices for secondary students with disabilities and identified in-school predictors of postschool success for students with disabilities are aligned with effective practices for physical therapists. Additionally, suggestions for involving physical therapists in transition planning and increasing collaboration in providing transition services for students with disabilities are provided. Physical therapists can provide critical expertise for many individuals with disabilities; however, they are not always included effectively in transition planning and services for students with disabilities. Recommendations for practice include ways to involve physical therapists in transition planning and services and increasing collaboration between teachers, physical therapists, and other members of the Individualized Education Program team to provide effective, comprehensive transition services.

Commentary on "Relationship of School-Based Physical Therapy Services to Student Goal Achievement".

“How should I apply this information?” As related service providers, school-based physical therapists (SBPTs) are charged by the Individuals with Disabilities Education Act (IDEA) to prepare children with disabilities for the postschool outcomes of “further education, employment and independent living.”1 However, SBPTs in this study underemphasized their contributions to self-care (eg, toileting, dressing, and feeding) and academics, which are predictors of success in these postschool outcomes.2 One way SBPTs can increase their focus on both self-care and academics is by supporting the Physical Education and Health curriculum established in each state. As an added benefit, this study supported that working on self-care is associated with exceeding goal expectations for posture and mobility. This is likely due to the repeated opportunities to practice both posture and mobility when performing self-care, such as toileting, multiple times during the school day. This study highlights the importance of services on behalf of the student (eg, consultation, collaboration, and documentation) when working toward posture and mobility goals. By consulting and collaborating with educators, SBPTs can influence class routines to increase the frequency of practice of desired skills (including self-care) during the school day. This increased frequency of practice can, in turn, promote motor learning.3 When working toward recreational and fitness goals, this study supports the SBPTs' use of functional strengthening and mobility interventions to improve playground access. “What should I be mindful about when applying this information?” As clearly stated by the researchers, this study does not establish causation, but associations between school-based physical therapy services and exceeding goal expectations. Therefore, as SBPTs modify the emphasis of their interventions based upon the conclusions of this study, they should closely monitor the response of each student to such interventions and adjust accordingly. For future studies, SBPTs would benefit from learning the associations between service location and goal achievement. Carlo Vialu, PT, MBA Apply EBP, LLC New York Laurie Ray, MPT, PhD North Carolina Department of Public Instruction Raleigh, North Carolina University of North Carolina at Chapel Hill Chapel Hill, North Carolina The authors declare no conflicts of interest.

Development of student goals in school-based practice: physical therapists’ experiences and perceptions

Purpose: Development of individualized student goals is integral to special education. Although United States federal legislation and state, local, and professional guidelines outline preferred goal development processes, actual practice does not always reflect ideal practice. The purposes of this research were to understand how physical therapists develop student goals and to identify facilitators and barriers to development of participation-based goals.Methods: Twenty school-based physical therapists participated in one of five semi-structured focus groups. Two researchers conducted thematic analysis of transcriptions of audio recordings to identify qualitative themes; a third researcher reviewed the analysis.Results: Five themes emerged related to therapists’ recommendations for goal development: (1) Understand the student: The foundation for individualized goal development, (2) Teaming: The critical component to integrate varied perceptions and establish a common vision, (3) Relevant focus of goal: Addressing what is meaningful for a student’s day, (4) Best practices: Embracing professional advances, and (5) Develop and write the goal: The art and science of writing goals. The first four themes also reflected facilitators and barriers to development of participation-based goals.Conclusions: Therapists’ comments reflected striving to follow ideal practice recommendations despite identified challenges. This research helps educational teams understand and reflect on goal development processes.Implications for rehabilitationAlthough writing goals is a foundational task in school-based practice, meaningful goal development is a complex process.School-based physical therapists recommend working closely with students, parents, teachers, and other members of the educational team to establish good communication, trust, and a shared philosophy of collaboration and responsibility for student goalsA thorough understanding of the student serves as the foundation for developing individualized student goals.Educational teams are encouraged to understand professional, federal, state, and local guidelines and embrace professional advances in goal development practices.

School-Based Physical Therapists’ Experiences and Perceptions of How Student Goals Influence Services and Outcomes

Aims: Individualized goals are the foundation for physical therapy services and outcomes. This research describes school-based physical therapists’ (PTs) experiences and perceptions of how student goals impact services and outcomes. Methods: Twenty school-based PTs participated in one of five semi-structured focus groups on goal development and use. Therapists were recruited from 113 therapists who participated in a study of school-based physical therapy outcomes. Two researchers conducted thematic analysis of written transcriptions of audio recordings to identify qualitative themes; a third researcher reviewed the analysis. Results: Four themes emerged related to how goals impact services: (1) the nature of services, (2) intervention strategies, (3) teaming, and (4) flexibility of services. Three themes emerged related to how goals impact outcomes: (1) natural linkages among goals, services, and outcomes; (2) goals impact teaming to achieve outcomes; and (3) specifics of the goal matter. Therapists also reported a range of student and environmental factors that impact services and outcomes. Conclusions: Therapists perceive that goals influence services and outcomes in complex ways, especially due to the flexibility and individualization needed in school-based practice. This study helps school-based PTs understand and reflect on how individualized goals influence services and optimize student outcomes.

Should school-based physical therapists be more targeted in their interventions for children with disabilities?

This commentary is on the original article by McCoy et al. on pages 1140–1148 of this issue.

Goal Development Practices of Physical Therapists Working in Educational Environments

ABSTRACTAims: The aims of this study were to (1) describe the practices that school-based physical therapists use in developing student goals, and (2) identify facilitators and barriers to development of goals that are specific to participation in the context of the school setting. Methods: 46 school-based physical therapists who participated in a previous study on school-based physical therapy practice (PT COUNTS) completed a questionnaire on goal development. Frequencies and cross tabulations were generated for quantitative data. Open-ended questions were analyzed using an iterative qualitative analysis process. Results: A majority of therapists reported that they frequently develop goals collaboratively with other educational team members. Input from teachers, related services personnel, and parents has the most influence on goal development. Qualitative analysis identified five themes that influence development of participation-based goals: (1) school-based philosophy and practice; (2) the educational environment, settings, and routines; (3) student strengths, needs, and personal characteristics; (4) support from and collaboration with members of the educational team; and (5) therapist practice and motivation. Conclusion: Goal development is a complex process that involves multiple members of the educational team and is influenced by many different aspects of practice, the school environment, and student characteristics.

Concurrent Validity of the School Outcomes Measure (SOM) and Pediatric Evaluation of Disability Inventory (PEDI) in Preschool-Age Children

ABSTRACTAims: The purpose of this study was to examine the concurrent validity of the School Outcomes Measure (SOM) compared with the Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children. This study also examined the consistency of children's motor performance across the home and school settings. Methods: Five school-based physical therapists collected data on 44 preschool-age children with physical or combined physical and cognitive disability. Correlation coefficients analyzed the strength of association between SOM and PEDI subscale scores, while participant group mean scores analyzed agreement between measures regarding level of motor performance. Results: Correlations between homologous PEDI and SOM subscale scores varied from rs = .53 to rs = .92 supporting concurrent validity. With some exceptions, group mean SOM scores showed agreement with group mean PEDI scores when children were categorized by age, gross motor function level, or PEDI cutoff score (1 or 2 SD below the mean). Conclusions: The results partially support concurrent validity between the SOM and PEDI, and suggest that the children's motor performance was similar across home and school settings. The findings also suggest that as a minimal database the SOM can reliably assess motor performance in the school setting; the disadvantage is difficulty interpreting SOM scores.

Physical Therapists’ Perceptions of School-Based Practices

ABSTRACTAims: Surveys have reported that most school-based physical therapists perceive ideal practices are not commonly implemented in their settings. Our aim was to obtain a more in-depth understanding of these perceptions through open-ended inquiry. Methods: Qualitative data were derived from voluntary open-ended responses provided upon completion of a survey regarding school-based physical therapy practice. Of the survey's 561 participants, 250 provided open-ended commentaries that were analyzed using interpretive phenomenology. Results: Six qualitative themes emerged from the open-ended responses, including: In quest: Meeting students’ school-based needs via physical therapy; Seeking relatedness: Finding working teams in the school system; Building understanding: Developing a voice/identity in the school context; Stretched beyond limits: Managing workloads; Networking: Coordinating services outside school to meet student needs; Defying definition: What does working in an educational model mean? Conclusions: School-based physical therapists seek to meet educationally relevant physical therapy needs of students, ages 3 to 21 years. Successes appear woven of a multitude of factors such as therapist expertise, team dynamics, and district supports.

Nationwide survey of school-based physical therapy practice.

The Individuals with Disabilities Education Improvement Act and related literature have implications for school-based physical therapy. This study examined therapists' reports of their actual practice, compared with literature-based recommendations for "ideal" practice, and explored their conceptions of ideal practice. Participation in an online survey was requested of school-based physical therapists. Analysis of the results compared the therapists' reports of their actual practice with their views about ideal practice. Among the 561 respondents, there was general agreement that actual practice was always or usually consistent with the literature. However, poor agreement was found between their reported actual practice and their opinions of ideal practice. The majority of service delivery was direct intervention. Ninety percent believed they were "adequately" meeting their students' needs. Actual reported practice generally met literature descriptions of ideal practice but not to the extent the respondents thought ideal.

Continued Ambulation Gains Through High School in a Student With Cerebral Palsy

The purpose of this case report is to describe school-based physical therapy services received throughout high school by a student with diplegic cerebral palsy and to share her functional gains. This previously discharged 15-year-old freshman was re-referred due to a perceived walking regression using long-leg braces/reverse rolling walker and her desire to again try crutches. She subsequently resumed walking, typically 4 days per week at school and progressed to axillary crutches on level surfaces and stairs. Gross Motor Function Measure scores increased from 66.4% freshman year to 78.8% senior year, with the greatest dimension changes in standing (35.9%-69.2%) and walking, running, and jumping (8.3%-25.0%). School-based physical therapists are uniquely positioned to work with students in natural environments to optimize activity and participation. This report shows that continued ambulation gains in individuals with cerebral palsy are possible throughout adolescence.

Factors Affecting Prescription and Implementation of Standing-Frame Programs by School-Based Physical Therapists for Children with Impaired Mobility

The purpose of this study was to investigate factors considered in the prescription and implementation of standing-frame programs by school-based physical therapists. A 20-item survey was mailed to 500 members of the APTA Pediatric Section and School-Based Special Interest Group. Survey questions addressed standing-frame program prescription and perceived benefits. Response rate was 77.2%. A majority of respondents rated ambulatory status for the prescription of standing-frame programs and a child's specific needs in the selection of a specific standing frame as very important. Respondents identified multiple benefits with pressure relief rated very important most frequently. More than 50% of respondents indicated social and educational benefits are very important. A majority of respondents prescribed standing-frame programs for 30-45 minutes daily. Variation does exist, but the majority of school-based physical therapists agree on several key factors in the prescription and implementation of standing-frame programs.

School-Based Pediatric Physical Therapists’ Perspectives on Evidence-Based Practice

This study described the current knowledge, beliefs, attitudes, and practices of a group of school-based pediatric physical therapists regarding evidence-based practice (EBP). Five practitioners participated in this project. Each was interviewed individually and in a group and completed a quantitative survey. All of the participants had a positive attitude toward EBP and believed that it should be an important element of clinical practice. Knowledge and practice were more variable, with several individuals reporting a lack of confidence in this area and an inability to routinely implement EBP. These participants were more likely to rely on colleagues, interaction with their supervisor, and professional experience to aid in decision making than research evidence. Pediatric physical therapists face numerous challenges accessing, analyzing, and applying research evidence. It is critical for the profession to identify optimal ways to support practitioners in this aspect of clinical practice.

Decision Making for Physical Therapy Service Delivery in Schools: A Nationwide Analysis by Geographic Region

This study investigated the relationship between geographic practice location and recommendations for the contexts and frequencies of physical therapy service delivery in schools. Participants were 626 school-based physical therapists from all 50 states. Four case descriptions were presented in the survey: a four-year-old girl with motor delays and typical cognitive functioning, a four-year-old girl with motor and cognitive delays, a six-year-old boy with spastic diplegic cerebral palsy, and the same boy at 12 years of age. Proportionally fewer respondents in the Northeast recommended providing services in exclusively natural settings, as compared with other regions. Respondents in the Northeast recommended mean monthly frequencies of at least one more session for each case (3.7-7.6) than those in the other regions: West (2.5-5.5), South (1.6-4.7), and Midwest (1.6-4.5). These findings suggest an association between geographic region of practice among school-based physical therapists and the contexts and frequencies of service delivery.