School-based Physical Therapy 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.

A Preliminary Study to Develop a Collaborative Tiered School-Based Physical Therapy Service Delivery Model: Results from an International Delphi Consultation

A Preliminary Study to Develop a Collaborative Tiered School-Based Physical Therapy Service Delivery Model: Results from an International Delphi Consultation

Changes in Writing and Addressing Student Goals During COVID-19 for Virtual and Hybrid School-Based OT, Physical Therapy, and Speech-Language Pathology: A Qualitative Analysis

Abstract Date Presented 04/01/2022 During the 2019–2020 school year, school-based therapists working in the school setting quickly migrated to online and hybrid service delivery as a result of the COVID-19 pandemic. Changes continued throughout the 2020–2021 school year. The purpose of this research is to describe how OTs, physical therapists (PTs), and speech-language pathologists (SLPs) developed and addressed goals for students who received therapy services via online or hybrid schooling during the COVID-19 pandemic. This research was recently presented at ASHA and APTA, 2021. Primary Author and Speaker: Sonja Burmeister Contributing Authors: Kimberly D. Wynarczuk, Rebecca Bawayan, Eric Sanders, Brianna Milstrey

Regional Differences in School-Based Physical Therapy Practice for Students Who Made Progress on 2 Outcome Measures.

This study examined whether regional differences exist in the provision of school-based physical therapy services for students who achieved positive progress and explored relationships between student outcomes and school-based physical therapy. Physical therapists developed student goals using Goal Attainment Scaling (GAS) and administered the School Function Assessment (SFA). Therapists documented activities, interventions, and type of service delivery provided weekly. Students were assigned to regions for analysis. Student GAS goal attainment and progress on the SFA did not vary significantly among regions. The dosage of school-based physical therapy services, interventions, and activities varied. There were regional differences that did not impact goal achievement. Further research is needed to identify the most efficient and effective interventions and dosage to support student outcomes.

Commentary on “Regional Differences in School-Based Physical Therapy Practice for Students Who Made Progress on 2 Outcome Measures”

Commentary on “Regional Differences in School-Based Physical Therapy Practice for Students Who Made Progress on 2 Outcome Measures”

Análisis de la situación de la fisioterapia en los centros educativos en España

Background and objectiveStudents with special educational needs may need the specific and specialized support of Physiotherapy in order to facilitate the development of their maximum potential and help in their educational inclusion. The information about school-based Physical Therapy development in Spain is very scarce. The objective of this study is to describe the situation of physiotherapy in educational centers and compare it among the different autonomous communities. Materials and methodsA descriptive and cross-sectional study was carried out through the elaboration of an online survey, designed together with a panel of experts using the Delphi method. Six thematic blocks were included related to the provision of the physiotherapy service, working conditions and the coverage of the students’ needs. Results178 responses were obtained. Their geographical distribution was homogeneous, although large differences were detected among the autonomous communities. Most of the participants work in special education centers and there are autonomous communities in which physical therapists do not work in ordinary centers. Only 28.4% answered that the physiotherapist is integrated into the educational orientation teams of their autonomous community and has the function of determining the need for the resource. ConclusionsSchool-based Physiotherapy services to support students with special educational needs is unequal among the autonomous communities, and in some of them it is considered insufficient.

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.

Commentary on "A Structured Goal-Setting Process to Promote Functional and Measurable Outcomes in School-Based Physical Therapy: A Knowledge Translation Study".

Commentary on "A Structured Goal-Setting Process to Promote Functional and Measurable Outcomes in School-Based Physical Therapy: A Knowledge Translation Study".

A Structured Goal-Setting Process to Promote Functional and Measurable Outcomes in School-Based Physical Therapy: A Knowledge Translation Study.

Goal setting is an important component of school-based physical therapy; however, evidence suggests that therapists may not consistently write goals that are relevant, context specific, and measurable. The aims of this knowledge translation study were to evaluate implementation of a goal-setting method for school-based therapists. This study was created to align with the Knowledge to Action framework and included 1-day training and follow-up mentorship. Goals were assessed pre- and posttraining, and questionnaires assessed barriers and facilitators. Twenty-two physical therapists participated. Nineteen participants (90%) strongly agreed/agreed that the training helped change their perspectives about goal setting in the school environment. There was a statistically significant difference in goal quality pre- and posttraining. Therapists identified barriers and facilitators to implementation of effective goal setting in practice. Results indicate that this method may be effective at improving goal writing that is relevant, context specific, and measurable in school settings.

Commentary on "School-Based Physical Therapy Services: Predicting the Gap Between Ideal and Actual Embedded Services".

Commentary on "School-Based Physical Therapy Services: Predicting the Gap Between Ideal and Actual Embedded 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.

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

To explore the relationships of school-based physical therapy services to student goal achievement. One hundred nine physical therapists and 296 students participated in a practice-based study. Therapists formatted goals using goal attainment scaling and evaluated goal achievement. Using the School-Physical Therapy Interventions for Pediatrics system, therapists documented services weekly for 20 weeks. Group comparisons and logistic regressions were conducted. For primary goals, no documented physical therapy services were associated with exceeding goal expectation. For posture/mobility goals, more minutes in self-care activities and services on behalf of the students were associated with exceeding goal expectation; use of cognitive and behavioral training interventions was associated with not exceeding goal expectation (P < .05). For recreation/fitness goals, greater use of functional strength and mobility for playground access and cognitive/behavioral interventions were associated with exceeding goal expectation (P < .05). A limited number of physical therapy services was associated with exceeding goal expectation.

Racial and Ethnic Disparities in Autism-Related Health and Educational Services.

The objective of this study is to measure racial and ethnic disparities in autism-related services among U.S. children with parent-reported autism spectrum disorder (ASD). Using the 2011 Survey of Pathways to Diagnosis and Services, we analyzed parent-reported data on 1420 children with current ASD in the nationally representative sample. An estimation method consistent with the Institute of Medicine's definition of health care disparities is used to measure racial and ethnic disparities. The findings revealed Latino-white disparities in the percentage of children currently using school-based occupational and physical therapy and Latino-white and "other race"-white disparities in the percentage of children using physical therapy outside of school. There were no statistically significant black-white disparities. Instead, the study found that the percentage of black children with ASD receiving school-based services was 8 points higher than that of white children (p < 0.04). Factors unrelated to the need for autism services were largely unassociated with the receipt of services. The findings provide a partial baseline and identify a need for further examination of the source of existing disparities and the lack of disparities found for specific services and minority groups.

A Preliminary Study to Develop a Collaborative Tiered School-Based Physical Therapy Service Delivery Model: Results from an International Delphi Consultation

Background: Physical therapy (PT) is increasingly provided at schools to help students participate in educationalactivities. Recent rehabilitation models emphasized the benefits of using collaborative tiered services for serviceprovision, yet no model is available to guide how these services should be delivered. Therefore, this study aims to determine the core attributes and PT interventions of a collaborative tiered school-based PT model that could guide how PT services are delivered in schools worldwide.Methods: A modified Delphi method was used to identify the core attributes and the PT interventions that would be part of the model. An introductory webinar followed by three Delphi rounds with 24 international experts was conducted. Similar ideas generated in Round 1 were combined into statements; the statements reaching the predetermined consensus level in Rounds 2 or 3 were retained. Categories were created to present core attributes and Tiered interventions that were retained.Results: 41 core attributes were identified and grouped under seven categories. Tiered interventions were grouped under 15 categories which included 37 interventions for Tier 1, 24 interventions for Tier 2, and 60 interventions for Tier 3.Conclusion: The recommended core attributes and interventions will support the development of an international framework for school-based PT services, fostering health promotion for all children, and supporting those with disabilities.

Description of School-Based Physical Therapy Services and Outcomes for Students with Down Syndrome.

Students with Down syndrome (DS) receive school-based physical therapy (SBPT), however little data exists regarding services and outcomes. Using a prospective observational cohort study our aim was to explore SBPT activities and interventions, and students' goal achievement of 46 students with DS, tracked by 17 physical therapists (PTs). PTs provided on average 24.0min/week direct service and 11.6min/week services on behalf of the student. The most frequent activities employed were physical education/recreation, mobility, and sitting/standing/transitions. The most frequent interventions implemented were neuromuscular, mobility, and musculoskeletal. Although students individually met 69.5% of their primary outcome goals, their achievement could not be explained by total minutes of either direct and minutes on behalf of SBPT, nor minutes spent in most frequent activity.

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.

Description of the Services, Activities, and Interventions Within School-Based Physical Therapist Practices Across the United States.

Students with disabilities receive school-based physical therapy services under the Individuals with Disabilities Education Improvement Act of 2004. Little research exists regarding therapy services in schools. This study explored the school-based services that students received and the activities and interventions that physical therapists implemented, and determined if services differed based on the student's functional gross motor ability and age. This was a prospective observational cohort study using a practice-based evidence design. Data were collected by 109 physical therapists for 296 students, aged 5 to 12 years, receiving school-based physical therapy. Physical therapists completed the School-Physical Therapy Interventions for Pediatrics data form for 20 weeks during 1 school year. This evaluation included the type of service delivery, the amount of time spent on each student (consultation/documentation), minutes spent in activities, the specific interventions implemented, and the student's level of participation. The Gross Motor Function Classification System (GMFCS) was used to describe the students' functional ability. Physical therapists provided an average of 26.7 min/wk (standard deviation [SD]=15.1) of direct services and 13.1 min/wk (SD=7.7) of services on behalf of the student. Primary activities were physical education/recreation (7.7 min/wk, SD=8.2), mobility (6.7 min/wk, SD=7.9), and sitting/standing/transitions (6.3 min/wk, SD=8.1). Primary interventions were neuromuscular (32.5 counts per student, SD=15.9), mobility (15.3 counts per student, SD=14.65), and musculoskeletal (14.4 counts per student, SD=10.3). Differences existed based on GMFCS but not student age. Physical therapists reported School-Physical Therapy Interventions for Pediatrics data weekly, not necessarily after each therapy session. The GMFCS was used as a proxy of students' functional gross motor ability. Our description of services is provided to encourage physical therapists to reflect on the services they provide and to foster future examinations of service effectiveness.

School-based physical therapy services and student functional performance at school.

We explored relationships of school-based physical therapy to standardized outcomes of students receiving physical therapy. Using a practice-based evidence research design, School Function Assessment (SFA) outcomes of 296 students with disabilities (mean age 7y 4mo [standard deviation 2y]; 166 males, 130 females), served by 109 physical therapists, were explored. After training, therapists completed 10 SFA scales on students at the beginning and end of the school year. Therapists collected detailed weekly data on services (activities, interventions, types, student participation) using the School-Physical Therapy Interventions for Pediatrics (S-PTIP) system. Stepwise linear regressions were used to investigate S-PTIP predictors of SFA outcomes. Predictors of SFA section outcomes varied in strength, with the coefficient of determination (R2 ) for each outcome ranging from 0.107 to 0.326. Services that correlated positively with the SFA outcomes included mobility, sensory, motor learning, aerobic/conditioning, functional strengthening, playground access interventions, and higher student participation during therapy (standardized β=0.11-0.26). Services that correlated negatively with the SFA outcomes included providing services within student groups, within school activity, with students not in special education, during recreation activities, and with positioning, hands-on facilitation, sensory integration, orthoses, and equipment interventions (standardized β=-0.14 to -0.22). Consideration of outcomes is prudent to focus services. Overall results suggest we should emphasize active mobility practice by using motor learning interventions and engaging students within therapy sessions. No specific interventions predicted positively on all School Function Assessment (SFA) outcomes. Active movement practice seems related to overall better SFA outcomes. Active mobility practice improved SFA participation, mobility, recreation, and activities of daily living. Engaging students in therapy activities and interventions improved outcomes.

Determining Need for School-Based Physical Therapy Under IDEA: Commonalities Across Practice Guidelines.

The Individuals with Disabilities Education Act (IDEA) includes physical therapy (PT) as a related service that may be provided to help students with disabilities benefit from their education. However, the IDEA does not provide specific guidance for the provision of school-based PT, resulting in variations in practice across the United States. The authors examined 22 state and local education agency guidelines available online to find commonalities related to the determination of a student's need for PT. Seven commonalities found: educational benefit, team decision, need for PT expertise, establishment of Individualized Education Program (IEP) goal before determining need for PT, distinction between medical and educational PT, the student's disability adversely affects education, and the student's potential for improvement. These commonalities are discussed in relation to current PT and special education literature. This article suggests applying these commonalities as procedural requirements and questions for discussion during an IEP team meeting.