Knowledge Of Therapists Research Articles

Therapist knowledge, adherence and use of low back pain guidelines to inform clinical decisions – A national survey of manipulative and sports physiotherapists in New Zealand

Identifying factors which influence guideline-informed clinical decisions by therapists will help tailor implementation strategies to improve guideline use. The aims of this study were to investigate; the extent to which current physiotherapy practice in New Zealand adheres to low back pain (LBP) guidelines and the factors which influence the use of guidelines to inform clinical decisions for patients with non-specific low back pain (NSLBP). A cross-sectional on-line survey of NZ physiotherapists (n = 1039) was conducted which included the guideline adherence measures, therapists' treatment orientation about NSLBP and a question on the perceived helpfulness of guidelines in decisions for patients with NSLBP. Data from 170 physiotherapists were analysed descriptively and univariate and multivariate associations were conducted for therapist factors (predictor variables) which predicted guidelines being helpful in decisions for management of patients with NSLBP (Y|N). The majority of respondents provided advice which was broadly inline with guideline recommendations [work (60%), activity (87.6%), and bed rest (63%)]. A lower biomedical belief orientation for LBP, higher reported LBP caseload and postgraduate qualifications demonstrated significant univariate associations (P ≤ 0.20) for guidelines being helpful to inform decisions for a patient with NSLBP. The only significant (P = 0.043) predictor variable in the multivariate model was the therapists' biomedical treatment orientation (Exp (B): odd ratio: 1.56). Differences between behaviours and beliefs in guideline use were found. A lower focus on a biomedical model for LBP influenced usage of LBP guidelines to inform clinical decisions for patients with LBP. Implications for improving guideline usage are discussed.

Fonoaudiologia e humanização: percepção de fonoaudiólogas de um hospital público

OBJETIVO: investigar o conhecimento e aplicação da Política Nacional de Humanização por fonoaudiólogos de um hospital público de Belo Horizonte. MÉTODO: trata-se de um estudo qualitativo que teve como instrumento de coleta de dados um formulário elaborado pelas pesquisadoras. A amostra foi composta por 25 fonoaudiólogas de um hospital público. Foi realizada análise quantitativa das questões de caracterização da amostra e análise quanti-qualitativa de conteúdo na qual foram identificadas e elencadas as categorias de análise e a frequência de ocorrência dos conteúdos e expressões para as questões discursivas. RESULTADOS: na análise quantitativa, percebeu-se que 68% das fonoaudiólogas eram formadas há mais de cinco anos; 88% tinham pós-graduação; 56% atuavam na área de Audiologia; 52% atuavam também em instituições privadas e 60% referiram conhecer a PNH. Na análise qualitativa, as necessidades/demandas apontadas para garantia do atendimento humanizado constaram dos eixos temáticos gestão e organização dos serviços de saúde, instrumentalização do trabalhador da saúde, multiprofissional e intersetorial, além do respeito às demandas e direitos do usuário. CONCLUSÃO: o conceito de humanização apresentado pelas fonoaudiólogas está em consonância com o descrito na PNH. E quanto aos eixos para garantia da atenção humanizada tomando com referência a instituição, o usuário e o profissional, as entrevistadas citaram parcialmente os princípios da Política Nacional de Humanização.

A Qualitative Investigation of Physical Therapists' Experiences and Feelings of Managing Patients With Nonspecific Low Back Pain

Physical therapists' management of patients with nonspecific low back pain (NSLBP) has been found to be associated with their beliefs and attitudes toward NSLBP, as well as with guideline recommendations. Greater knowledge of physical therapists' experiences and feelings of treating patients with NSLBP may help to explain these associations and increase our understanding of some of the challenges physical therapists face when treating patients with NSLBP in clinical practice. The objective of this study was to understand more about how the personal experiences and feelings of physical therapists might influence their decision making when treating patients with NSLBP. This was a qualitative study using a phenomenological hermeneutical approach and practitioner-as-researcher model. Eleven semistructured interviews with physical therapists were conducted and analyzed using the hermeneutical circle to identify key themes relating to their experiences and feelings in treating patients with NSLBP. Three linked themes emerged: (1) physical therapists believe that NSLBP has an underlying mechanical and recurring nature, (2) physical therapists' attitude toward managing NSLBP is to empower patients to exercise and self-manage their pain and functional problems, and (3) physical therapists experience feelings of tension between the advice and treatment they feel is best for their patient and the patient's own beliefs and attitudes. The experiences and feelings of physical therapists treating patients with NSLBP include conflict among their pain beliefs, attitudes, and working partnerships with patients. Treatment decisions may be influenced when physical therapists modify their beliefs and attitudes to reduce this sense of conflict. Improving physical therapist communication skills may help decrease feelings of conflict, enhance working relationships, and encourage a more consistent approach toward patients with NSLBP.

Attitude, knowledge and behaviour towards evidence‐based medicine of physical therapists, students, teachers and supervisors in the Netherlands: a survey

Evidence-based medicine (EBM) has gained widespread acceptance in physical therapy. However, because little is known about the attitudes, knowledge and behaviour of physical therapists towards EBM, and their participation in research to generate EBM, we explored these aspects among physical therapy students, teachers, supervisors and practising physical therapists. This is a cross-sectional survey in which participants completed a web-based questionnaire to determine their attitudes, knowledge and behaviour regarding EBM, and their participation in research. Questionnaires were sent to 814 participants of which 165 were returned. The overall mean score for attitude was 4.3 [standard deviation (SD) 1.0; range 1-7], which indicates a weak positive attitude. Teachers scored the highest (4.9, SD 1.2) and students the lowest (4.1, SD 0.8). Although most participants had some understanding of the technical terms used in EBM, only teachers felt able to explain these terms to others. Of the students, 45% rated their perceived EBM knowledge as bad and 45% as average, whereas 78% of the teachers considered that they had good knowledge. To answer clinical questions, most students generally use textbooks (96%) and the opinion of their supervisors (87.7%). There is a weak positive attitude of physical therapists, teachers, supervisors and students towards participating in research in general practice, but there is a lack of knowledge and active behaviour regarding EBM, especially among physical therapy students.

Developing, Maintaining, and Using a Body of Knowledge for the Massage Therapy Profession

The diverse field of massage therapy has lacked a formal body of knowledge to serve as a practice and educational foundation and to guide future development. This deficit has hampered the growth of the profession and its acceptance and recognition by the medical and allied health care community. To provide massage therapists, bodyworkers, physicians, educators, and associated allied health care professionals in the United States with a description of the purpose and development of the massage therapy body of knowledge (MTBOK) and recommendations for its future development and utilization. Professional groups in the massage therapy community came together and established a task force to develop a body of knowledge for the profession. Five groups became the stewards for this effort. A nationwide search produced a task force of eight volunteers from diverse areas of the profession charged with the responsibility of researching and developing the MTBOK document. Review of documents, curricula, state laws and regulations, certification exam content, interviews, and public comment resulted in the development of the MTBOK. During development multiple opportunities for comment and discussion by stakeholders (public) were provided in an effort to create a professional consensus. The resulting MTBOK document establishes professional descriptions of the field; scope of practice; knowledge, skills, and abilities for entry-level massage therapists; and definitions for terminology to insure standardization, in order to provide a foundation for future discussion and growth. The MTBOK fulfills the goal for which it was developed, to serve as a foundation for the growth and development of the massage therapy profession as a whole. A living document, it should continue to evolve and grow with the profession. Maintenance and continued stewardship of this document by the massage therapy community is vital for continued professional progress.

Restraint of children with additional needs in motor vehicles: Knowledge and challenges of paediatric occupational therapists in Victoria, Australia

This research project aimed to understand the challenges faced by occupational therapists when making recommendations regarding the restraint of children with additional needs in motor vehicles in Victoria, Australia. A cross-sectional survey design was used to explore current practice in relation to the prescription of motor vehicle restraints in Victoria, Australia. An electronic survey was sent to occupational therapists working with children aged from birth to 18 years in early intervention services, hospitals, schools, community services or private practice. Challenges faced by occupational therapists related to a lack of knowledge of relevant standards and legal requirements, issues seating children with behavioural difficulties, families' inability to purchase recommended equipment and constraints as a result of funding issues. Further work is required to develop appropriate resources which support occupational therapists to make car seating recommendations for children with additional needs which comply with Australian legal requirements and standards.

Evaluation of a Pilot Bridging Program to Enable Australian Dental Therapists to Treat Adult Patients

This study evaluated a pilot educational bridging program designed to provide dental therapists in Australia with the appropriate knowledge and skills required to enable them to translate their current clinical scope of practice to adult patients. Ten dental therapists completed a bridging program consisting of forty-two hours of didactic content, fourteen hours of clinical observation, forty-two hours of clinical practicum under direct supervision, and 105 hours of clinical experience with supervision by mentoring dentists. Process and impact evaluation was undertaken at various stages of the program by participants and supervising dentists. Self-reported confidence and knowledge for dental therapists had increased at the completion of the course. Supervising dentists reported high levels of knowledge for dental therapists after completing the course and said that the course adequately prepared the dental therapists to translate their current clinical scope of practice to treat adult patients. Eight of the ten participants successfully completed the assessment at the completion of the course and were permitted by the Dental Practice Board of Victoria to extend their clinical scope of practice to adult patients aged twenty-six years of age or more. The dental therapists thought that the educational model was relevant in developing their clinical skills. The evaluation indicates that this model is an effective method of extending the scope of practice for dental therapists and has important implications in enhancing the flexibility of the dental team.

Smoking Cessation and Counseling: Knowledge and Views of Canadian Physical Therapists

Physical therapists are uniquely positioned in health care to initiate or support smoking cessation (SC). Little is known, however, about their knowledge and views of SC as part of their practices. Objective The purpose of this study was to assess Canadian physical therapists' knowledge about the health effects of smoking, their views about addressing SC in practice, and their self-efficacy in enabling patients to quit smoking. Design This study was a cross-sectional survey. Licensed physical therapists in Canada were surveyed with postal methods. A total of 738 survey questionnaires were returned. The mean age and years of clinical experience of the respondents were 41.9 (SD=10.8) years and 17.4 (SD=11.0), respectively. Most respondents (78.6%) were women. Canadian physical therapists are largely informed about the negative effects of smoking on health. Although 76.9% of the physical therapists agreed or strongly agreed that the profession should be more involved in helping people who smoke quit, only 56.8% of the physical therapists agreed or strongly agreed that they should receive training on SC. More than 70% of the physical therapists reported that they were not prepared to provide counseling and, overall, the level of self-efficacy regarding counseling about SC was low. Lack of resources and time were reported to be key barriers to counseling patients to quit smoking. Limitations The findings of this study are limited to Canadian physical therapists. Response bias and social desirability bias also are potential limiters in this study. Overall, the majority of physical therapists expressed the view that advising people who smoke to quit is a clinical responsibility and endorsed greater involvement of the profession in helping people who smoke quit. Discordance existed, however, between these views and the physical therapists' interest in receiving training on counseling about SC. This is a benchmark study that has practical implications for targeting training consistent with the profession's mission to improve health by increasing physical therapists' preparedness and self-efficacy regarding counseling about SC.

Therapist competence, therapy quality, and therapist training

Large numbers of therapists worldwide wish to receive training in how to deliver psychological treatments. Current methods of training are poorly suited to this task as they are costly and require scarce expertise. New forms of training therefore need to be developed that are more cost-effective and scalable. Internet-based methods might fulfil these requirements whilst having the added advantage of being able to provide trainees with extensive exposure to the treatment as practised. New strategies and procedures for evaluating training outcome are also required. These need to be capable of assessing the therapist’s knowledge of the treatment and its use, as well as the therapist’s ability to apply this knowledge in clinical practice. Standardised role play-based techniques might be of value in this regard.

A Survey of Screening and Practice Patterns Used for Patients With Osteoporosis in a Sample of Physical Therapists From Illinois

Physical therapists provide care for many patients who are at risk or have been diagnosed with osteoporosis. Currently, little information exists about what physical therapists know about osteoporosis, how they screen for the condition, and how they manage patients with osteoporosis. This study assessed knowledge and confidence of physical therapists in screening, examining, and planning interventions for persons diagnosed or at risk for osteoporosis. A survey was mailed to 250 randomly selected members of the Illinois Physical Therapy Association. A follow-up mailing was sent to those who had not replied within 3 months. Survey items focused knowledge and confidence with screening and developing interventions for persons with osteoporosis. Response rate was 41% with a final sample of 83, 3 respondents meeting the inclusion criterion (working with women age 40-90). The majority of respondents were confident (35%) or somewhat confident (47%) in their ability to recognize risk factors for osteoporosis. The majority correctly identified female gender (68%), history of fracture (88%), and family history of osteoporosis (80%) as risk factors for osteoporosis, and identified changes in height (86%), and changes in posture (90%) as indicators for screening. Only 35% would often or always identify Asian American individuals as appropriate for screening for osteoporosis. Respondents appropriately prescribed log rolling for bed mobility (82%), rest in a supine position (45%), "hip hinge" as a method for sit to stand (48%), and wall slides (52%). Although more than 55% reported never prescribing high-risk exercises such as toe touches, abdominal machines, or abdominal crunches, 33% would prescribe high-risk exercises such as rest in a sitting position (37%) and a "nose over toes" method of sit-stand (36%). It appears physical therapists correctly screen and identify some risk factors for osteoporosis; more education is needed in certain areas of screening and interventions for those with osteoporosis.

Knowledge, skills and professional behaviours needed for occupational therapists and physiotherapists new to work-related practice

The paper seeks to identify the key knowledge domains, skills and professional behaviours required to prepare occupational therapists and physiotherapists for employment in work related practice. Twelve experienced work related practitioners in one Australian state participated in face to face semi-structured interviews. PARTICIPANTS represented the majority of perspectives in the field and in addition to professional qualifications, a number of participants were employers or contractors of therapists. The paper reviews existing evidence about knowledge, skills and professional behaviours in the field. The results of a study examining requisite knowledge, skills and professional behaviours for occupational therapists and physiotherapists follow. Interviews were analysed using the Leximancer™ text analysis program developed at The University of Queensland. A high level of congruence was evident in key areas of knowledge, skills and professional behaviours between all interviewees and the literature. Findings included the need for very good communication skills by both professions and the need for a sound grounding in specific disciplinary skills. Results identified that occupational therapists take a broad view of function and task analysis and that physiotherapists have good skills in anatomy, musculoskeletal assessment and movement analysis. These results are considered in relation to planning the clinical education of OT and PT students in preparation for work related practice.

Teaching mindfulness to psychotherapists in clinical practice: The Mindful Therapy Programme

AbstractIntroduction: Initially proposed as a treatment modality for psychological disorders, mindfulness is now being promoted as a means of enhancing both therapist self care and therapeutic efficacy. The degree to which mindfulness can be learned by therapists to manage their own and clients' processes in therapy is as yet unknown. This study examines training outcomes of a standardised introductory mindfulness programme for mental health professionals. Methods: Forty‐seven mental health professionals completed an eight‐week mindful therapy (MT) training programme and associated measures. Results: Compared with baseline scores, participants demonstrated knowledge acquisition on all measures, including increased mindfulness in clinical work, increased capacity to intentionally invoke mindful states of consciousness, and higher participant ratings of well‐being over the course of training sessions. Discussion: This research provides preliminary evidence that a brief, standardised mindfulness training programme can achieve acceptable knowledge and skills outcomes for therapists that can aid their therapeutic practice. Of note, increased ‘therapeutic mindfulness’ in this study resulted from changed mindfulness ‘attitudes’ (i.e. a more accepting and equanimous orientation within therapeutic work) as opposed to a clear demonstration of increased attention‐regulation skills. The implications of these and other results for programme development and wider research are discussed.

Promoting the Use of Measurement Tools in Practice: A Mixed-Methods Study of the Activities and Experiences of Physical Therapist Knowledge Brokers

The use of knowledge brokers (KBs) has been recommended as a mechanism to facilitate the use of research evidence in clinical practice. However, little has been written regarding the practical implementation of the KB role. This article (1) describes the brokering activities of 24 pediatric physical therapist KBs (in Ontario, Alberta, and British Columbia, Canada), and (2) reports KBs' perceptions of the utility of their role and their experiences with the brokering process. A mixed-methods research design was used in this investigation, which was part of a larger knowledge translation (KT) study that demonstrated the effectiveness of using KBs to implement a group of evidence-based measurement tools into practice. The KBs completed weekly activity logs, which were summarized and described. Semi-structured telephone interviews with KBs were analyzed qualitatively to provide insight into their perceptions of their role and the brokering process. Major interview themes were identified and verified through member checking. Brokering activities varied considerably as KBs adapted to meet the needs of their colleagues. The KBs indicated that they highly valued the connection to the research community and spoke of the enthusiastic engagement of their physical therapist colleagues (and others in their organization) in the brokering process. They discussed the importance of understanding the practice context and organizational factors that could affect knowledge transfer. The KBs spoke of the need to dedicate time for the role and had a strong sense of the supports needed to implement a KB role in future. Considerable variation in brokering activities was demonstrated across KB participants. The KBs perceived their role as useful and indicated that organizational commitment is crucial to the success of this KT strategy.

Positioning Oneself Within an Epistemology: Refining Our Thinking About Integrative Approaches

Integrative approaches seem to be paramount in the current climate of family therapy and other psychotherapies. However, integration between and among theories and practices can only occur within a specific epistemology. This article makes a distinction between three different epistemologies: individualizing, systems, and poststructural. It then makes the argument that one can integrate theories within epistemologies and one can adopt practices and some theoretical concepts across theories and across epistemologies, but that it is impossible to integrate theories across epistemologies. It further states that although social constructionism has influenced much of contemporary psychological thinking, because of the divergence between a structural and a poststructural approach, constructionism looks different depending upon one's epistemological stance. Examples of integration within epistemologies and of what looks like integration across epistemologies (but is not) further illustrate these important distinctions. The conclusions reached here are crucial to our philosophical considerations, our pedagogical assumptions, and implications for both research and a reflexive clinical practice.

Physical Activity Promotion in the Physical Therapy Setting: Perspectives From Practitioners and Students

Physical inactivity is a major risk factor for chronic disease. Primary health care practitioners are well placed to promote a physically active lifestyle. The perceptions and practice of physical therapists on their role in physical activity promotion are not well known. The objective of this study was to determine the knowledge, confidence, role perception, barriers, feasibility, and counseling practice of physical therapists and physical therapist students regarding the promotion of nontreatment physical activity for better health. A cross-sectional survey was conducted. In 2008, 321 (54%) of a random sample of all physical therapists registered in New South Wales, Australia, responded to a survey on their knowledge, confidence, role perception, barriers, feasibility, and counseling practice with regard to promoting a physically active lifestyles to their patients. Physical therapist students (n=279) completed the same survey but without the questions on barriers and counseling practice. Physical therapists and physical therapist students consider that it is part of their role to give their patients nontreatment physical activity advice. Overall, they reported having adequate knowledge and skills to undertake this role. Incorporating advice into normal consultations is deemed the most feasible form of lifestyle physical activity promotion in physical therapist practice. The cross-sectional nature of this study makes it difficult to determine cause and effect relationships. Some selection bias may have occurred, as the physical therapists who completed the questionnaires may have been those most interested in physical activity promotion. Physical therapist practice appears to be an excellent avenue for promoting a physically active lifestyle and could potentially play an important public health role.

From Cawthorne-Cooksey to Biotechnology: Where We Have Been and Where We Are Headed in Vestibular Rehabilitation?

Vestibular rehabilitation has come a long way from Cawthorne and Cooksey exercises. Although revolutionary in their foresight and still in use today, the available options for rehabilitation of vestibular disorders has dramatically in recent years. Currently in our armamentarium are specific exercises to address gaze instability, postural instability (static and dynamic), motion sensitivity, and vertigo—all symptoms relative to pathology within the peripheral and central vestibular pathways. Cochrane studies have established that vestibular rehabilitation is effective for treating unilateral peripheral vestibular hypofunction. Recent treatment guidelines and systematic reviews suggest that repositioning maneuvers are the superior treatment for benign paroxysmal positional vertigo. Our knowledge of testing and treatment of pathologies affecting the peripheral vestibular labyrinth and/or the pathways mediating vestibular afference is exploding. Just as optimal intervention for individuals with vestibular disorders commonly involves multiple disciplines, so are multiple disciplines conducting excellent research that demands vigilance in the practicing clinician. As clinicians who treat people with vestibular disorders, our interventions would be enhanced by examining data from other disciplines: emerging evidence suggests that new tests may isolate utricular from saccular function, migraines can be triggered by vestibular stimulation, and technical advances in oculomotor equipment now enable video monitoring and recording of rapid head and eye rotations. Today there are many tests that can be used by clinicians, which provide clinically meaningful information. In addition, as members of the vestibular team, physical therapists need to become more involved in other professional meetings to inform other clinicians about what we have to offer. Important opportunities for collaborating might involve the American Academy of Head and Neck Surgery, the Association for Research in Otolaryngology, and the biannual Barany Society meeting. We are pleased to report that this Special Issue of the JNPT has and outstanding cadre of international authors and coauthors from the United States, the United Kingdom, Greece, Saudi Arabia, Jordan, and Australia. The topics covered are diverse and so is the authors' expertise. The authors include physical therapists, engineers, and physicians who work to enhance the care of persons with vestibular disorders. The authors were asked to contribute to this issue based on their novel work, and we hope that their recent findings help to improve care for your patients. Most of the articles in this Special Issue include advanced technology as part of their methods. The use of the vibrotactors (Wall), scleral search coils (Scherer and Schubert), uniquely applied measures of attention (Mohammad et al), and optokinetic stimulation (Pavlou et al) all involve some degree of innovative technology to assess treatment effectiveness, measurement of vestibular function, or reveal behavior in people with vestibular dysfunction. Other articles in this issue attempt to describe treatment effectiveness in interesting patient groups including mild traumatic brain injury related to blunt (Alsalaheen et al) and blast (Gottshall) trauma, patients with report of dizziness but normal caloric findings (Hall et al), patients with canal-only versus canal and otolith dysfunction (Murray et al), and differences between treatment paradigms (Clendaniel). The future for vestibular rehabilitation is exciting and will involve interaction with multiple disciplines. In a recent survey of biomechanics laboratories, physical therapists who responded to an informal survey participated in projects in >75% of the laboratories. Physical therapists were the largest group represented at the 2010 International Gait and Mental Function meeting. In the future, we expect the merging of vestibular physical therapy with technical innovations to include virtual reality feedback/training, a vestibular prosthesis, even stem cell research to resolve pathophysiology within the labyrinth. These new technologies will need the skills and knowledge of physical therapists to help investigators determine whether the interventions are effective and/or to establish the behavioral implications of stem cell physiology to restore function. Most certainly, other clinicians/researchers will look to physical therapists for better understanding of movement problems of people with vestibular and other neuromotor disorders, and for optimal rehabilitation approaches to maximize the value of technology. We encourage all readers to examine the foundational science and evidence for using new and innovative technologies before adopting the newest device for use with their patients. Material in this Special Issue was chosen to highlight some of the investigators around the world who are making a difference in the care of people with vestibular disorders. Many basic clinical questions remain, and we still struggle with issues such as optimal dose, optimal type of exercise, and the value of continuing a home exercise program after discharge. We hope that this Special Issue will help clinicians explore some new innovations and discoveries in physical therapist examination and treatment of persons with vestibular disorders.

Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective.

Evidence-based practice (EBP), a preferred psychological treatment approach, requires training of community providers. The systems-contextual (SC) perspective, a model for dissemination and implementation efforts, underscores the importance of the therapist, client, and organizational variables that influence training and consequent therapist uptake and adoption of EBP. This review critiques the extant research on training in EBP from an SC perspective. Findings suggest that therapist knowledge improves and attitudinal change occurs following training. However, change in therapist behaviors (e.g., adherence, competence, and skill) and client outcomes only occurs when training interventions address each level of the SC model and include active learning. Limitations as well as areas for future research are discussed.

Knowledge, attitudes, practices and barriers of pediatric occupational therapists to evidence-based practice and research utilization

Knowledge about the use of evidence-based practice and research utilization continues to develop and expand within the occupational therapy field. The aim of this study was to investigate and compare the perceived knowledge, attitudes, practices, barriers and orientation to evidence-based practice and research utilization of a group of pediatric occupational therapists from Australia, the United Kingdom, and Taiwan. Questionnaires were received from 696 participants (response rate 56.58%) who completed the Research Knowledge, Attitudes and Practices of Research Survey (KAP Survey), the Barriers to Research Utilization Scale (BARRIERS), and the Edmonton Research Orientation Survey (EROS). The results indicated pediatric occupational therapists held positive attitudes towards evidence-based practice but were less confident in their research knowledge and practices. The greatest barriers to research utilization were associated with the “Organization”, with participants rating some engagement in research conduct and utilization. Similarities and differences were noted between countries regarding various aspects of evidence-based practice and utilization. Findings also indicated that evidence-based practice and research utilization in the context of pediatric occupational therapy practice vary from one country to another and that these issues are impacted by both personal and workplace related issues.

Cervical Arterial Dysfunction: Knowledge and Reasoning for Manual Physical Therapists

This clinical commentary provides evidence-based information regarding adverse cerebrovascular events in the context of manual therapy assessment and management of the cervical spine. Its aim is to facilitate clinical decision making during diagnosis and treatment of patients presenting to the therapist with cervicocranial pain. Rather than focusing on a traditional view of premanipulative testing as the cornerstone for decision making, we present information concerning the clinical presentation of specific vascular conditions. Additionally, we discuss the assessment and management of musculoskeletal pain in the presence of risk factors for cerebrovascular accident. It is proposed that vascular "red flag" presentations mimic neuromusculoskeletal cervicocranial syndromes. Invariably, the 2 conditions coexist. This reasoning presupposes that some patients who have poor clinical outcomes, or a serious adverse response to treatment, may be those who actually present with undiagnosed vascular pathology. We use 2 case reports to demonstrate how incorporating vascular knowledge into clinical reasoning processes may influence clinical decision making. Level 5.

Physical Therapists’ Experiences Updating the Clinical Management of Walking Rehabilitation After Stroke: A Qualitative Study

Little is known about physical therapists' experiences using research evidence to improve the delivery of stroke rehabilitation. The purpose of this study was to explore how physical therapists use research evidence to update the clinical management of walking rehabilitation after stroke. Specific objectives were to identify physical therapists' clinical questions related to walking rehabilitation, sources of information sought to address these questions, and factors influencing the incorporation of research evidence into practice. Two authors conducted in-depth telephone interviews with 23 physical therapists who treat people with stroke and who had participated in a previous survey on evidence-based practice. Data were analyzed with a constant comparative approach to identify emerging themes. Therapists commonly raised questions about the selection of treatments or outcome measures. Therapists relied foremost on peers for information because of their availability, ease of access, and minimal cost. Participants sought information from research literature themselves or with the help of librarians or students. Research syntheses (eg, systematic reviews) enabled access to a body of research. Older therapists described insufficient computer and search skills. Most participants considered appraisal and application of research findings challenging and identified insufficient time and peer isolation as organizational barriers to the use of research. Physical therapists require efficient access to research syntheses primarily to inform the measurement and treatment of walking limitation after stroke. Continuing education is needed to enhance skills in appraising research findings and applying them to practice. Older therapists require additional training to develop computer and search skills. Peer networks and student internships may optimize the exchange of new knowledge for therapists working in isolation.