Therapist Competence Research Articles

Who Gets Top Jobs of Physical Therapy in Pakistan

Physical Therapy is a healthcare profession, in which Physical Therapist provides treatment to individuals developing, maintaining and restoring the maximum functional capacity throughout life. Physical therapy is amongst one of the neglected health care elds in Pakistan due to lack of resources and absence of a professional regulatory body. Even after 60 years of inception of physical therapy, there is no regulatory council in Pakistan. However, some of the priva t e bodi e s had be en working for professional growth. Of these, Pakistan Physiotherapy Society (PPS), Chartered Society of Physiotherapy (CSP) of Pakistan and Pakistan Physical Therapy Association (PPTA) are worth 1 mentioning . Research on the relationship between education and employment has received signicant attention in recent years. It is now well recognized that there are many other factors intervene in the relationship between education and unemployment. From getting admission for higher education to getting a perfect job, substantial socio-economic differences are present at every stage. The evidence strongly suggests that, even after taking these factors into account, graduates from affuent families are more likely to obtain a professional job and to see higher earnings 2 growth in the labor market . To get jobs in physical therapy, along with getting excellence in graduation, knowledge level, clinical skills, some of graduates make themselves competent than others by means of research publications which really have a signicant impact on getting job. Continuing medical education also highlights candidates in a bunch of unemployed population for their distinctive certications and hence, for them, chances of being hired increase. Unfortunately, in Pakistan, graduates with less ma rks , poor knowl edge , no r e s e a r ch publications and post-graduation get better job status only with their political affliations on references basis. In contrast, many deserving graduates, not all, justifying the criteria for employment, remain empty handed with their degrees proving it correct that, "reference dominates merit".Sadly, the significance of this profession in Pakistan is yet to be recognized. Moreover, so far, the campaigns and initiatives which are being taken for the betterment of PT profession are at best poor. This situation is leading to brain drain as graduates are still having apprehensions about their future. They are hired at low remuneration. This is increasing further frustration& depression among fresh graduates. There is no job structure and no vacancies are announced. In Pakistan, things are moving towards the scenario where graduates are more grappling towards finding a strong reference rather than being competent physical therapists. This profession has a great importance in making life worth living. Need has been highlighted for the proper service structure in government as well as private institutions, research, development and training based on international standards. Jobs should be created by the federal and provincial governments. The struggle for the regulatory body is the best of advancement in the development of this profession. As the situation is worsening day by day, the government must take special measures to save this profession

How students use deliberate practice during the first stage of counsellor training

AbstractDeliberate practice, in the form of ongoing commitment to skill development outside of direct clinical work, has been proposed as a means of enhancing therapist competence and expertise. In this study, a deliberate practice orientation was introduced into the first phase of a counsellor training programme. Students’ experiences of learning and using deliberate practice in relation to the acquisition of counselling skills were investigated using a mixed‐method design. It took time for students to internalise principles of deliberate practice. They reported a wide range of deliberate practice learning activities, both within and beyond the classroom, and regarded these tasks as having made a significant positive contribution to their learning. The findings of the study underscore the value of viewing deliberate practice as an approach to learning that can be articulated in multiple ways. It is important for future research to identify the forms of deliberate practice that are most relevant to enhancing competence within the specific context of therapeutic work.

Are therapist adherence and competence related to clinical outcomes in cognitive-behavioral treatment for youth anxiety?

Studies have found that psychological treatments produce positive clinical outcomes for many problems experienced by youth. However, there is limited research on whether therapist adherence and competence in delivering these treatments are related to differential clinical outcomes. We examined the relationship of therapist adherence and competence to clinical outcomes in a sample of 51 youth aged 7-14 years (M age = 10.36, SD = 1.90; 86.3% white; 60.8% male) treated for anxiety disorders with a manualized individual cognitive-behavioral therapy. Adherence and competence were measured via coding of recorded treatment session content and outcomes were measured by caregiver and youth report across multiple timepoints. We used two-level mixed-effects regression models to test the degree to which adherence and competence predicted differential youth clinical outcomes. Across multiple caregiver- and child-reported symptom and diagnostic outcomes, we found no statistically significant relationship between adherence or competence and clinical outcomes. Although there was variability in both treatment integrity and clinical outcome, neither adherence to nor competence in youth anxiety treatment was related to clinical outcomes for youth with anxiety disorders treated with individual cognitive-behavioral treatment (CBT) in a research clinic-based efficacy trial. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cognitive therapy compared with CBT for social anxiety disorder in adolescents: a feasibility study.

Social anxiety disorder (SAD) is common, typically starts in adolescence and has a low natural recovery rate. Existing psychological treatments for adolescent SAD are only moderately effective. It is possible that recovery rates for adolescents could be substantially improved by adapting a psychological therapy that is highly effective among adults with SAD. To train child and adolescent mental health services (CAMHS) therapists to deliver cognitive therapy for SAD in adolescents (CT-SAD-A) and assess therapist competence. To estimate the costs to the NHS of training therapists to deliver CT-SAD-A and the mean cost per adolescent treated. To examine the feasibility of a randomised controlled trial (RCT) to compare CT-SAD-A with the general form of cognitive-behavioural therapy that is more commonly used. During the training phase of the study, it became clear that the RCT would not be feasible because of high staff turnover and unfilled posts within CAMHS and changes in the nature of referrals, which meant that few young people with primary SAD were accessing some of the participating services. The study design was altered to comprise the following: a training case series of CT-SAD-A delivered in routine CAMHS, an estimate of the cost to the NHS of training therapists to deliver CT-SAD-A and of the mean cost per adolescent treated, and qualitative interviews with participating young people, parents, therapists and service managers/leads. Five CAMHS teams within Berkshire Healthcare and Oxford Health NHS Foundation Trusts. Eight therapists received training in CT-SAD-A. Twelve young people received CT-SAD-A, delivered by six therapists. Six young people, six parents, seven therapists and three managers participated in qualitative interviews. Cognitive therapy for social anxiety disorder in adolescents (CT-SAD-A). Measured outcomes included social anxiety symptoms and diagnostic status, comorbid symptoms of anxiety and depression, social and general functioning, concentration in class and treatment acceptability. Patient level utilisation of the intervention was collected using clinicians' logs. Nine out of 12 participants achieved good outcomes across measures (r ≥ 0.60 across social anxiety measures). The estimated cost of delivering CT-SAD-A was £1861 (standard deviation £358) per person. Qualitative interviews indicated that the treatment was acceptable to young people, parents and therapists, but therapists and managers experienced challenges when implementing the training and treatment within the current CAMHS context. Findings were based on a small, homogeneous sample and there was no comparison arm. CT-SAD-A is a promising treatment for young people with SAD, but the current CAMHS context presents challenges for its implementation. Further work is needed to ensure that CAMHS can incorporate and test CT-SAD-A. Alternatively, CT-SAD-A should be delivered and tested in other settings that are better configured to treat young people whose lives are held back by SAD. The new schools Mental Health Support Teams envisaged in the 2017 Children's Mental Health Green Paper may provide such an opportunity. The National Institute for Health Research (NIHR) Health Technology Assessment programme. Individual funding was also provided for Cathy Creswell, David M Clark and Eleanor Leigh as follows: NIHR Research Professorship (Cathy Creswell); Wellcome Senior Investigator Award (Anke Ehlers and David M Clark); and the Wellcome Clinical Research Training Fellowship (Eleanor Leigh).

Exploring Our “Deltas”: A Training Tool for Conceptualizing Systemic Theory of Change

Systematically utilizing theory to guide clinical practice is integral to developing and maintaining therapist competency. However, helping Marriage and Family therapist trainees develop their own theory of change can be a challenging training component and more educational guides are needed to help facilitate the learning process. This paper introduces the Delta Model for conceptualizing systemic change as such a tool. The proposed Delta Model is introduced and guidelines for specifically teaching trainees at each level of the Delta are provided. The proposed model will be applied to a case vignette and discussion of additional considerations for applying the Delta Model beyond clinical practice will be reviewed.

Therapist competence and clinical outcome in the rehabilitation of memory following traumatic brain injury trial

ABSTRACT Objectives: Therapist competencies when delivering an intervention can impact clinical outcomes. However, the relationship between competence and outcome in the context of memory rehabilitation has not previously been investigated. We aimed to evaluate whether therapist competencies in delivering a group-based memory rehabilitation intervention, as part of a randomized-controlled trial, was associated with changes in clinical outcome in the participants with traumatic brain injury. Method: Outcome data on the Everyday Memory Questionnaire (EMQ) and Goal Attainment Scaling (GAS) were obtained for 24 participants of the memory rehabilitation trial. Video recordings of intervention sessions delivered by six therapists were coded using a checklist designed to evaluate therapist competence in group facilitation. Results: Therapists demonstrated consistently high levels of competency in facilitating the memory group. Correlational analyses showed that there was a non-significant weak association between EMQ and therapist competence (r = .28, p = .18), and between GAS and therapist competence for short- and long-term goals (r = −.33, p = .12 and r = −.24, p = .25, respectively). Conclusions: We found no significant association between competence and outcome in this memory rehabilitation trial. This may reflect insufficient variability in therapist competence and/or the nature of the clinical outcome measures used. Further research is needed to understand competence-outcome relationships in cognitive rehabilitation.

Rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament reconstruction: An online survey

ObjectivesThe primary objective of the study was to investigate rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament (ACL) reconstruction. Secondly, we aimed to investigate physical therapists’ preferences on continuing education and evaluate their self-rated confidence and competence when treating patients before and after ACL reconstruction. DesignSurvey-based study. SettingOnline survey platform. ParticipantsFlemish physical therapists (n = 283). Main outcome measuresThe online survey consisted of a combination of 40 open- and closed-ended questions, divided across 5 sections: (1) participant demographics and clinical practice information, (2) patient population information, (3) continued education practices, (4) rehabilitation strategies, and (5) physical therapist self-rated confidence and competence to treat patients with ACL reconstruction. ResultsA wide variability in rehabilitation strategies were found across the whole ACL rehabilitation continuum, which were in general not in line with best available evidence. Nevertheless, the overall self-rated confidence and competence of physical therapists treating patients before and after ACL reconstruction were high. ConclusionOur findings indicate a need to improve rehabilitation practices before and after ACL reconstruction. Advanced research dissemination and implementation are required to achieve better rehabilitation outcomes.

Foundations for Training Psychedelic Therapists.

This chapter presents an integrative model for training psychedelic therapists. It begins with an overview of the psychedelic healing process - remembering the disconnected parts of ourselves and reestablishing fundamental trust. The authors then walk through six therapist competencies that describe the root principles of practice, breadth of knowledge, transpersonal perspective, and therapeutic stance of a psychedelic practitioner. This model includes 12 curricular areas and didactic methods that support the therapist's process of growth. Finally, the authors link their training philosophy to the current needs of society, offering a vision of how to express psychedelic integration through the honoring of diversity and collaboration.

Supplemental Material for Effects of Competence Feedback on Therapist Competence and Patient Outcome: A Randomized Controlled Trial

Supplemental Material for Effects of Competence Feedback on Therapist Competence and Patient Outcome: A Randomized Controlled Trial

Formation of the competencies of future teacher-speech therapists in the field of intercultural communication

This article discusses topical issues of future speech therapists’ training in terms of a competence approach. Special attention is paid to formation of universal competences of future teachers in the field of intercultural collaboration. Current bachelor training curricula of specialized (speech pathology) education of speech therapy major 44.03.03 have been analyzed regarding formation of competences of future speech therapists in the field of intercultural communication. Efficient intercultural communication does not emerge spontaneously, it should be consistently developed. Modern life calls for mastering the skills of such communication. At present, special attention is paid to formation of universal competences in future speech pathologists, especially aimed at intercultural collaboration. It is believed that a speech therapist possessing such competences will be able to perceive cultural diversity of society in social, historical, and philosophical contexts. This article analyzes the experimental study of development level of future speech therapists’ general cultural competences. Junior and senior students from the Department of speech therapy, Institute of special education and psychology, Moscow City University took part in this research. The main experimental method was a survey of students. Particular attention was paid to the issues of formation of speech culture of speech therapists and the possibility to apply knowledge acquired during studies of a humanitarian module in professional activities of cultural and educational type. The main results of the analysis are a proven opportunity of updating theoretical knowledge of speech therapists in the field of intercultural communication acquired during studies of humanitarian, psychological, pedagogical and professional sections using interactive approaches to teacher activities.

Study of the Levels and Secular Changes of Clinical Competencies of Physical Therapists

Study of the Levels and Secular Changes of Clinical Competencies of Physical Therapists

The Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM): Development and Validation of a New Tool to Assess Therapist Adherence and Competence

ABSTRACT Objective Mindfulness-Oriented Recovery Enhancement (MORE) is a mind-body therapy that unites complementary aspects of mindfulness training, third-wave cognitive behavioral therapy (CBT), and principles from positive psychology into an integrative treatment for addiction and its comorbidities. As interest in MORE has grown among researchers and clinicians, there is an increasing need to provide quality assurance measures to ensure treatment integrity during implementation of MORE. Here, we describe the development and validation of the Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM). Method We developed a 17-item scale assessing therapist competence and adherence to the MORE treatment manual, which was then used for fidelity monitoring of 40 MORE treatment sessions across two Stage 2 and two Stage 1 RCT for addictive behaviors (e.g., opioid misuse, obesity) involving a total N = 295. Results Internal consistency for the Adherence (α =.89) and Competence subscales (α =.92) was high, and interrater reliability was adequate (Adherence subscale ICC =.77; Competence subscale ICC =.51), with therapists exhibiting good-to-excellent levels of fidelity across all trials. Importantly, linear mixed modeling indicated that higher levels of overall fidelity were associated with greater reductions in opioid misuse across two Stage 2 RCTs (F 1,48.00 = 7.38, p=.009), indicating that the MORE-FM is a valid measure of treatment fidelity that can predict clinical outcomes. Conclusions Findings from this study yielded insights for future iterations of the MORE-FM. In sum, the MORE-FM is a valuable tool for assessing and enhancing the integrity of MORE in future research trials and clinical applications.

Assessing panic disorder-specific competencies: evaluation of the Cognitive Therapy Competence Scale for panic disorder.

Evidence-based treatment for panic disorder consists of disorder-specific cognitive behavioural therapy (CBT) protocols. However, most measures of CBT competence are generic and there is a clear need for disorder-specific assessment measures. To fill this gap, we evaluated the psychometric properties of the Cognitive Therapy Competence Scale (CTCP) for panic disorder. CBT trainees (n = 60) submitted audio recordings of CBT for panic disorder that were scored on a generic competence measure, the Cognitive Therapy Scale - Revised (CTS-R), and the CTCP by markers with experience in CBT practice and evaluation. Trainees also provided pre- to post-treatment clinical outcomes on disorder-specific patient report measures for cases corresponding to their therapy recordings. The CTCP exhibited strong internal consistency (α = .79-.91) and inter-rater reliability (ICC = .70-.88). The measure demonstrated convergent validity with the CTS-R (r = .40-.54), although investigation into competence classification indicated that the CTCP may be more sensitive at detecting competence for panic disorder-specific CBT skills. Notably, the CTCP demonstrated the first indication of a relationship between therapist competence and clinical outcome for panic disorder (r = .29-.35); no relationship was found for the CTS-R. These findings provide initial support for the reliability and validity of the CTCP for assessing therapist competence in CBT for panic disorder and support the use of anxiety disorder-specific competence measures. Further investigation into the psychometric properties of the measure in other therapist cohorts and its relationship with clinical outcomes is recommended.

Importance and utilization frequency of essential competencies of Korean physical therapists

Importance and utilization frequency of essential competencies of Korean physical therapists

Clinical Translation of Cognitive Behavioural Therapy for Anxiety and Depression: Adapted for Brain Injury (CBT-ABI): How Do We Train Competent Clinicians?

Depression and anxiety are common following acquired brain injury (ABI) and can be effectively treated using cognitive behaviour therapy (CBT) that has been adapted to compensate for cognitive difficulties (CBT-ABI). Training clinicians to deliver CBT-ABI is a crucial step in effective translation into clinical practice. This study evaluated the outcome of didactic and skill-based training on competencies in delivering CBT-ABI. Participants were 39 registered psychologists who attended a day-long workshop on using CBT-ABI to treat anxiety and depression after ABI, which included knowledge and skill-based content. Fourteen participants completed three additional supervision sessions reviewing audio recordings of their use of CBT-ABI with clients. Training outcomes were measured using surveys rating the usefulness of the various workshop components, a checklist of competencies in CBT-ABI on which participants rated themselves pre-workshop and post-workshop and post-supervision, and the Cognitive Therapy Scale (CTS), used by supervisors and a blinded expert to evaluate supervisees’ skills. Participant-rated competencies in CBT-ABI significantly improved following workshop training, with no further change after supervision. CTS ratings of the supervisor, but not the blinded expert, showed significant improvement after short-term supervision. At 16-month follow-up, self-rated competency gains were maintained, and therapist confidence and competence were no longer major barriers to using CBT-ABI in the workplace. These findings suggest targeted training is important for clinical translation of this evidence-based intervention.

Client attendance measures in counselling psychology trainees

AbstractCounselling supervisors and educators have yet to reach a consensus about standard measures for evaluating the performance of graduate student therapists. Compared to self‐reports and rater judgements, client attendance records provide low‐inference behavioural data partially reflective of clients’ engagement with therapists. This naturalistic study evaluates client attendance data using archival records of 92 doctoral students in beginning and advanced counselling practica who produced data for 771 clients, 3,949 scheduled sessions and 3,186 attended sessions. Providing evidence of the sample representativeness for clinicians, results indicated that the mean number of sessions attended per client for student therapists (5.65) was very similar to that reported in the literature for outpatient therapists (<6). As expected because of structural differences in client assignment, beginning and advanced students evidenced statistically significant differences on attendance variables such as number of clients and scheduled sessions. In contrast, attendance ratios were equivalent across counsellor experience, suggesting that these individual difference variables could be useful for evaluation of therapist competencies related to client engagement.

The Characteristics of the Clinical Competence of Novice Physical Therapists and Occupational Therapists at the Time of Hiring in a Single Institution in Japan

PurposeTo identify the characteristics of the clinical competence of novice therapists at the time of hiring using the Objective Structured Clinical Examination (OSCE). MethodTwelve physical therapists and four occupational therapists participated in this study. The OSCE test comprised of attitudinal and technical items was administered at the time of hiring (10 days after the time of hiring). This research adopted three items which are widely used in clinical settings as a range-of-motion test, a muscle-strength test using a hand-held dynamometer, and Stroke Impairment Assessment Set. Each subject’s attitudinal and technical total scores were calculated. To compare the percentages of attitudinal and technical scores to the perfect score, Wilcoxon signed-rank test was used. In addition, a chi-square test and residual analysis were used to determine the bias of the technical subitem score distribution in each test. ResultsIn each test, the percentages of attitudinal total scores to the perfect score were higher than those of technical total scores. For the technical subitems in each test, the participants scored higher on simple tasks than on multiple tasks. ConclusionThis study suggests that postgraduate education focusing on technical items, especially multiple tasks, is necessary, because attitudinal items have been sufficiently acquired.

Pulse diagnosis in the Tibetan medical tradition: the experience of objectification of basic principles of pulse diagnosis using a pulse diagnostic device

This article describes the experience of objectification of basic characteristics of pulse waves in pulse diagnosis based on Tibetan medical tradition. A competent therapist – expert in Tibetan pulse diagnosis can assess functionality of the body (twelve internal organs and three psychophysiological systems) by feeling the pulse in six points of palpation located on the radial arteries of both wrists of the patient. The goal of this research consists in “teaching” pulse diagnostic device to recognize the diagnostically relevant characteristics of pulse waves. The article represents an attempt of objectification of the fundamentals of pulse diagnosis. Although pulse diagnosis has always been a subjective art of the talented therapist, its basic knowledge can become part of objective science as it is based on the real physical phenomena. The author describes the method of measuring pulse rate using a pulse diagnostic device in the conditions that create certain predictable responses of the body to an exogenous irritant, which in this case contributes to calming the rlung (wind) system. The experiment involved a group of volunteers. The conclusion is made that similar experiments provide material for the analysis of pulse waves acquired under specifically arranged conditions, which promotes the development of software fort the pulse diagnostic device, and proves that the objectification of fundamentals of pulse diagnosis in the Tibetan medicine is possible, although on a limited basis. The novelty is defined by the fact that the research based on the material of Tibetan medical tradition have not been previously conducted. The work consists of the three parts: first part is an extensive introduction that provides records on Buddhist medicine and pulse diagnosis, which help to understand the essence of the experiments; second part is dedicated to the experimental measurements of pulse rate using pulse diagnostic device; and third part represents the conclusions drawn from the conducted experiments.

Final Year Students' Knowledge on Basic Manual Wheelchair Provision: The State of Occupational Therapy Programs in Colombia.

Access to personal mobility is a human right and as such, it implies the provision of wheelchair services for those with mobility impairments that need one. Lack of appropriately trained personnel is a major contributor to the gap in access to wheelchairs. Assistive technology provision is one of the core competencies of occupational therapists. The goal of this study was to assess the current wheelchair provision knowledge of final year occupational therapy students in Colombia as measured by the International Society of Wheelchair Professionals Basic Wheelchair Service Knowledge Test. A total of 83 students from 7 universities took the test. None of the students met the 70% passing threshold. The highest scores were in the assessment domain while the lowest in the fitting and user training domains. These results suggest that the current wheelchair provision education received in these programs do not meet the World Health Organization guidelines on appropriate wheelchair provision. The implementation of strategies to improve current wheelchair provision education in Colombian occupational therapy programs is granted.

Defining and assessing key behavioral indicators of the Shifting Cultural Lenses model of cultural competence.

Models of cultural competence highlight the importance of the sociocultural world that is inhabited by patients, and the question of how best to integrate sociocultural factors into clinical assessment and intervention. However, one significant limitation of such approaches is that they leave unclear what type of in-session therapist behaviors actually reflect cultural competence. We draw on the Shifting Cultural Lenses model to operationalize culturally competent in-session behaviors. We argue that a key component of cultural competence is the collaborative relationship between therapists and patients, in which therapists shift between their own cultural lenses and those of their clients, as they co-construct shared narratives together. Accordingly, we propose that culturally competent therapist behaviors include accessing the client's views, explicitly presenting their own views as mental health care professionals, and working towards a shared understanding. We further specify the latter set of behaviors as including the practitioner's integration of the patient's view, their encouragement of the patient to consider their professional view, and the negotiation of a shared view. We developed a coding system to identify these therapist behaviors and examined the reliability of raters across 11 couple and 4 individual therapy sessions. We assessed whether the behavioral codes varied in expected ways over the first 3 sessions of 2 therapists' couple therapy as well. Operationalizing the behavioral indicators of the Shifting Cultural Lenses model opens the door to the integration of both process- and content-oriented approaches to cultural competence.