Therapist Assistants Research Articles

Companion animals as assistant therapists: embodying our animal selves

"Abstract: This article introduces the concept of Gestalt Animal Assisted Psychotherapy (GAAP). Clinical vignettes are used to demonstrate how companion animals enhance the therapeutic encounter within a Gestalt framework. The authors highlight the here and now, embodied, experimental and relational aspects of Gestalt therapy theory through their work. Key words: Gestalt, Animal Assisted Psychotherapy, GAAP, embodied, experiment, rela- tional, companion animal, non-verbal, inter-species, co-created."

Education Affects Attitudes of Physical Therapy Providers Toward People with Dementia

A survey was sent to every skilled nursing home (N = 495) in Indiana regarding the demographics, education, and whether the severity of dementia impacts the attitudes of people in physical therapy practice. Physical therapists (PTs) and physical therapist assistants (PTAs) practicing in nursing homes spend considerable time (44.0%) working with patients who have a diagnosis of dementia. As patients with dementia disorders declined cognitively, attitudes of PTs/PTAs become increasingly negative, and respondents feel that education, training, and resources are insufficient to maximize outcomes in the later stages of the disease.

Determinants of Rehabilitation Services Staffs' Job Satisfaction (By Effort Reward Imbalance) and Variations in Teaching, Profit Making and Non Profit Hospitals

To evaluate the level of work satisfaction based on the Effort-Reward Imbalance Model of staff working in rehabilitation services of different categories (in teaching, profit making and non-profit making hospitals). Participants were 166 therapists and assistants working in the Departments of Physical, Occupational and Respiratory Therapy from 10 hospital centers classified per three different categories in the Jeddah area. Effort-Reward Imbalance and staff satisfaction with intrinsic and extrinsic variables were measured by a self-administered questionnaire. There is a significant difference of level of job satisfaction measured by effort and reward imbalance between the therapists and assistant therapists working in the teaching, private or non-profit making health care facilities. In comparison by hospital type, the surveyed rehabilitation staffs presented a higher mean effort-reward imbalance in the teaching hospitals but higher job satisfaction with their salary, their perception of salary comparatively to others, yearly performance appraisal grading and affective commitment. In the rehabilitation services of non-profit making hospitals, the surveyed therapists and assistant therapists had the lowest mean Effort-Reward Imbalance ratio explained by their satisfaction with the variables of patient/staff ratio and emotional attachment to the organization. In the profit making healthcare facilities, the surveyed staffs are comparatively more satisfied with the variables of doctors' respect, involvement in quality improvement or educational lectures and transportation to/from work. Rehabilitation services staffs working in teaching hospitals and profit making hospitals had in general a higher effort-reward imbalance ratio with work stress and low satisfaction in work compared to the non-profit hospital facilities. Job satisfaction of rehabilitation staff varies per hospital type and mission of the health care facility. © Medwell Journals, 2012.

The Role of Physical Therapists in Smoking Cessation: Opportunities for Improving Treatment Outcomes

Tobacco use constitutes one of the greatest threats to public health worldwide. As a preventable cause of mortality and chronic disease, tobacco use in the United States results in an estimated 443,000 deaths each year through both direct exposure and secondhand smoke.1 An additional 8,600,000 people across the nation have chronic illness due to smoking.1 As physical therapists, we must realize that tobacco use affects all areas of our practice, including cardiovascular, musculoskeletal, neurological, and integumentary health throughout the life span. In order to provide optimal care for the clients we serve, it is essential for physical therapists to screen for tobacco use and incorporate cessation strategies as part of our interventions.2 There is a substantial unmet demand and opportunity for our profession to promote tobacco cessation.2 Despite evidence that links successful cessation to counseling by health care providers, fewer than 40% of insured adults report receiving such advice.3 In addition, receiving advice from 2 or more health care practitioners more than doubles the odds of successful cessation,4 further supporting the need for physical therapists and physical therapist assistants to contribute our skills and expertise as part of the interdisciplinary health care team. Successful cessation efforts have been demonstrated by other health care professionals, including physicians, dentists, dental hygienists, nurses, and pharmacists, and are an important component of preventive medicine and population health.5 According to the US Medical Expenditure Panel Survey, in 2007, physical therapists conducted a total of 88 million ambulatory visits for approximately 9 million adults aged 18 years and over.6 The number of visits (an average of 9.6 per patient, per episode)6 and nature of our interactions, which include extended, personalized, one-on-one care, present a unique opportunity for physical therapists and physical therapist assistants to provide support for …

The American Physical Therapy Associationʼs (APTA) Perspective on the Commission on Accreditation in Physical Therapy Education (CAPTE)

The purpose of this perspective is to contribute to the ongoing discussions concerning the nature of the administrative relationship between the Commission on Accreditation in Physical Therapy Education (CAPTE) and the American Physical Therapy Association (APTA). In recent years, CAPTE has considered its existing relationship with APTA and has expressed an interest in becoming an autonomous agency independent of APTA. The stated mission of CAPTE is to "serve the public by establishing and applying standards that assure quality and continuous improvement in the entry-level preparation of physical therapists and physical therapist assistants and that reflect the evolving nature of education, research and practice." We believe that the relationship of CAPTE and APTA has been complementary and supportive. In any relationship, involved parties should seek opportunity for improvement. In that vein, CAPTE and APTA are currently in conversation about opportunities for the future of their relationship. There are a number of relevant APTA policies/positions (that either originated in APTAs House of Delegates (APTA House) or APTAs Board of Directors (APTA Board) that are relevant to the understanding of the current discussions. Two policies/positions that we wish to highlight are APTAs House policy, "Accreditation Agency Recognition (CAPTE/APTA) (HOD P06-97-11-07)" and APTA's House policy, "CAPTE Responsibilities (HOD Y06-89-33-73)." We will frame our points about this current APTA and CAPTE conversation around these 2 items. The first position (Accreditation Agency Recognition) states that "there should be but one agency . . . recognized to accredit physical therapy education programs. . ." The essence of this policy forwards that "APTA supports the maintenance of the recognition of CAPTE by the US Department of Education and the Council for Higher Education Accreditation as the accrediting agency [for physical therapy education programs] and APTA . . . will render appropriate support to ensure accomplishment of the purpose of the accreditation program." We appreciate the wisdom of APTA's House of Delegates in clearly stating the importance of CAPTE and outlining the need to support the purpose of this important professional entity. We acknowledge that statements of support can be clear, while the details associated with carrying out the logistics of these declarations require ongoing diligence. It is that ongoing work and the challenges of those details that are the basis of the current dialogue between APTA and CAPTE. Some of the areas that APTA provides support for CAPTE include finance, information technology, Web services, meeting services, legal counsel, facilities, storage, and additional operational resources (offices, computers, etc). Beyond providing the oversight of educational programs, CAPTE also provides information to APTA member services and supplies data about programs and students that help in the areas of research, member services, and education agendas. All of the implications related to the current levels of support and exchange and how these relate to any change in relationship are a serious part of the consideration of both APTA and CAPTE as we discuss the future. The APTA House policy "CAPTE Responsibilities" states that "CAPTE shall be responsible for formulating, revising, adopting, and implementing the evaluative criteria for the accreditation of physical therapist assistant and physical therapist professional education programs." Again, APTA's Hosue was clear in its vision for CAPTE's mission. APTA has been a consistent supporter as CAPTE has established itself as a respected accrediting body. In recent years, CAPTE has demonstrated that it is capable of generating excess revenues beyond operating expenses. These revenues are primarily acquired from educational institutions. Under CAPTE's current arrangement, these revenues are returned to APTA at the end of each fiscal year- which is consistent with any of the revenue-producing units at APTA. …

Reflecting on Pediatric Physical Therapy in the International Community

Physical therapists and physical therapist assistants are a subset of health care providers taking on new roles in global health through international clinical experiences (ICE). During ICE, clinicians and students often work with patients and families. Each party brings with them health beliefs and interaction styles obtained from their families and communities. The revised code of ethics for physical therapists and the standards of practice for physical therapist assistants challenge us to be respectful of all patients we work with and to identify our own biases with regard to those we serve. Strategies used by clinicians have potential to greatly help or harm patients and families depending on the interaction approach used. It is important to be attentive to patients, families, family dynamics, and the expectations of the patient and family if the physical therapy interventions are to be optimally effective. An understanding of one’s own culture and personal values as well as the ability to detach oneself from personal views are essential to providing appropriate family-centered health care that empowers families rather than diminishes their ability to care for their children. This article discusses strategies of moving from not-knowing into knowing as we engage and empower the patients and families we encounter in the ICE setting through a reflective “I CANDO”model to promote sustainable care. Several case examples are provided which illustrate engaging families and communities in a culturally respectful manner which empowers families long after we leave the ICE setting.

Director of Clinical Education Performance Assessment Surveys: A 360-Degree Assessment of the Unique Roles and Responsibilities of This Position in Physical Therapy Education

Background and Purpose. Academic coordinators/directors of clinical education (DCEs) serve unique roles in physical therapist education programs with responsibilities that extend beyond those of teaching, service, and scholarship. Traditional faculty evaluation tools frequently fail to capture the diverse leadership, administrative, managerial, and experiential teaching responsibilities of these faculty members. The purpose of this project was to develop a set of assessment surveys for the DCE to use to solicit comprehensive performance feedback. Method/Model Description and Evaluation. A comprehensive literature review, analysis of professional documents and existing institutional tools, and feedback solicited from evaluator groups informed the development of the DCE Performance Assessment Surveys (Surveys). Fifty-six accredited physical therapist (PT) and physical therapist assistant (PTA) programs self-identified as the sample of convenience to pilot test the Surveys. Outcomes. The majority of program directors (88%) indicated they would consider using the Surveys. Clinical education faculty (88.6%) and academic faculty (84%) respondents stated they would be willing to complete a Survey for the evaluation of a DCE. A range of 85.0%-93.3% of respondents stated they could adequately evaluate the DCE using the Survey unique to their rater group and reported a range of 13.0-15.9 minutes to complete the Survey. Discussion and Conclusion. This project used a systematic process to develop a comprehensive set of Surveys for use in physical therapy academic programs. The Surveys solicit 360-degree performance feedback on the role of the DCE from the program director, DCE, clinical education faculty (clinical instructors, center coordinators of clinical education), academic faculty, and students. Data obtained may be useful to DCEs in professional and program development, workload allocation, promotion and tenure applications, and accreditation reports.

Blood Pressure Measurement Guidelines for Physical Therapists

Vital sign measurement and assessment are important components of the review of systems in a physical therapy examination for individuals with and without documented cardiopulmonary disease. The measurement of blood pressure gives the therapist information regarding the patient's baseline cardiovascular status, response to exercise/activity, and guides exercise prescription. Accurate measurement of blood pressure is critical for making appropriate clinical decisions especially if physical therapists wish to play an important role as primary health care providers. The purpose of this paper is to present recommended guidelines for blood pressure measurement by physical therapists and physical therapist assistants.

The National Physical Therapist Assistant Examination's First Time Pass Rates and Their Relationship to Education Program Faculty Attributes

Background and Purpose. There is a paucity of published literature regarding the correlation between faculty attributes and education program pass rates on the National Physical Therapy Examination (NPTE) particularly regarding the physical therapist assistant (PTA). The purpose of this study was to 1) determine if there is a relationship between faculty attributes in PTA educational programs and program outcomes on the NPTE for Physical Therapist Assistants (NPTE-PTA) and 2) construct a prediction model for PTA program outcomes based on faculty attributes. Subjects. The 233United States’ PTA programs accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) in 2006 were studied. Methods. Using a retrospective design, data were obtained regarding the PTA programs from the dataset of CAPTE’s PTA annual accreditation report and the Federation of State Boards of Physical Therapy’s pass rate database. Selected faculty attributes (designation of highest degree conferred, years of teaching experience, employment status, license designation [physical therapist or physical therapist assistant] and clinical specialization) were correlated to first time program pass rates. Backward deletion regression was used to predict the first time pass rate on the NPTE-PTA.Results. Based on data from 190/233 PTA programs, seven attributes had a statistically significant relationship to the outcomes on the NPTE-PTA. They were the number of: 1) full-time faculty; 2) adjunct faculty with an associate’s degree; 3) full-time faculty with a terminal degree; 4) core faculty with a terminal degree; 5) all faculty with a terminal degree 6) years of teaching experience of the full-time faculty; 7) years of teaching experience of the core faculty. Backward deletion regression analyses demonstrated an overall model of two combined predictor factors (full-time faculty years of teaching and full-time faculty terminal degree) that significantly predicted the first time pass rate on the NPTE-PTAaccounting for 6.5% of the variance. Discussion and Conclusion. Faculty attributes of the institutions providing PTAprograms are associated with first time pass rates of their graduates. This study provides a foundation for future studies by identifying some of the faculty attributes that relate to NPTE-PTA outcomes.

Factors Influencing Physical Therapist Assistant Licensure Examination Success

Background and Purpose. While there is considerable research regarding the predictability of various admission criteria and cognitive and noncognitive variables on licensure examination pass rates and other outcome measures in physical therapy and other health and nursing programs, minimal published attention has been given to these issues in physical therapist assistant programs. The purpose of this retrospective study was to examine the relationship between scores on the national licensure examination for physical therapist assistants (NPTE-PTA) and anatomy and physiology grades (A&P), grade point average in physical therapist assistant coursework (PTA GPA), and scores on the Physical Therapist Assistant Clinical Performance Instrument (PTA CPI). Subjects. Data of 72 students from the years 2003-2005 were collected from 7 New England-based physical therapist assistant programs (all 2-year academic institutions) and from the Federation of State Boards of Physical Therapy (FSBPT). Methods. Bivariate correlation values were examined among the variables, including PTA GPA, PTA CPI scores, A&P grades, and NPTE-PTA scores. Linear regression was explored to determine the predictive value of the independent variables in accounting for variance in NPTE-PTA score. Results. The correlation coefficient between PTA GPA and licensure examination scores (r = .48) was stronger than the previously reported values of between (r = .317 and .367). Discussion and Conclusion. PTA GPA was the best predictor for success on the NPTE-PTA based on higher examination scores. Likewise, this study also confirmed that CPI scores did not predict success on the licensure examination. While A&P grades appear to be valid with a positive, though weak, correlation-they are far less predictive for licensure examination scores than PTA-GPA. A predictive formula for licensure examination success has been proposed. Key Words: Academic administration, Higher education, Evaluation research, Student outcomes. BACKGROUND AND PURPOSE The physical therapist assistant (PTA) has been recognized by the American Physical Therapy Association (APTA) since 1964 as a paraprofessional in the field of physical therapy1 APTA subsequently authorized the training of PTAs at its 1967 Annual Conference.1 The majority of physical therapist assistant education programs are offered in community colleges, consist of approximately 2 years of academic and clinical education, and result in an associate's degree. In order to practice, a PTA must graduate from an accredited educational program. The Commission on Accreditation in Physical Therapy Education (CAPTE) is responsible for accrediting both physical therapist and physical therapist assistant education programs. Educational institutions provide annual data and outcome measures to CAPTE as part of the accreditation process.2 The range of outcome measures examined by CAPTE is similar for both physical therapist and physical therapist assistant education programs, and include graduation rates, licensure examination pass rates, and employment rates at 6 months post-graduation. In addition to graduation from a CAPTEaccredited educational program, 42 jurisdictions also require a passing score on a criterion-referenced licensing examination constructed and administered by the Federation of State Boards of Physical Therapy (FSBPT).3 The FSBPT assists licensing jurisdictions by identifying and promoting uniformity in physical therapy regulatory practices and standards. The same minimum passing score (600) for the Physical Therapist Assistant National Physical Therapy Examination (NPTE-PTA) is required in all of these jurisdictions. CAPTE requires that programs in such jurisdictions demonstrate an NPTE-PTA ultimate passing rate that averages at least 80% for the most recent 3 years.2 Ultimate passing rate is determined by the number of candidates who pass the exam, regardless of the number of attempts required. …

The Education Section: Casting a Broader Net

Change is everywhere: in health care, in education, in society. Change causes many emotions - excitement, discomfort, fear, exhilaration. In all cases, change brings opportunity. What we do with this opportunity is what determines the strength of who we are - as individuals, as physical therapists, as educators, and as an organization. A new CEO, a new manager, a new colleague, a new job, a new title, a new office - we have all experienced the discomfort that accompanies saying goodbye the old and having create the new without any guarantees. However, in many cases, these changes allow for growth, re-direction, and opportunities that may have been difficult had those changes not occurred. The Education Section, originally known as the Schools Section, is the oldest continuous section in the American Physical Therapy Association (APTA). It was made a permanent section in 1941 and is the only section not established under the aegis of the House of Delegates.1 In fact, at the time of the sections incorporation, APTA was still known as the American Physiotherapy Association. For many years, the Education Section has consisted of 4 distinct but overlapping member groups: special-interest groups (SIGs), the Academic Administrator SIG (AASIG), the Academic Faculty SIG (AFSIG), the Clinical Educator SIG (CESIG), and the Physical Therapist Assistant Educators SIG (PTAESIG). These groups have unique interests, concerns, and needs - all related education. Historically, the leadership of the Education Section has been overwhelmingly composed of individuals involved in academic institutions. The focus of much of the business and most of the activities of the section has been on supporting academic issues as they impacted the classroom and the clinic. With the evolution of physical therapy education progressing a doctor of physical therapy, the AASIG members determined that a different structure and organization was needed in order accomplish their goals of providing educational leadership. The Academic Council, functioning under the APTA Board of Directors, was formed to advance the enterprise of academic physical therapy by promoting the highest standards of excellence in academic programs.2 During the Business Meeting of the Education Section at the Combined Sections Meeting (CSM) in February 2011, the membership voted dissolve the AASIG. Throughout the development of the Academic Council, and under the assumption that AASIG issues would no longer drive its activities, the Education Section focused its attention on the opportunities and future goals for the section. The Executive Board of the section conducted a strategic planning session at CSM in February 2010 in San Diego. Enthusiasm was high and debates were lively as the future identity and purpose of the section were discussed. The result was a new brand, a new mission, and new goals that will inform the future activities and decisions of the section. The new brand is PT and PTA is an educator. Many of our guiding documents within APTA address our role as educators. The APTA Strategic Plan,3 adopted June 12, 2010, identifies education as a primary target area. The Code of Ethics for the Physical Therapist,4 Standards of Practice for Physical Therapy,5 and APTAs Guide for Conduct of the Physical Therapist Assistant6 address education as an obligation and commitment for the physical therapist and physical therapist assistant. Every clinician - no matter what the area of practice, level of expertise, or years of experience - spends more of his or her time educating others than on any other skill or activity. We educate our patients/clients, our colleagues, family members, students, caregivers, other health care providers, referral sources, third-party payers, legislators, attorneys - the list is endless. However, when we make decisions on how spend our continuing education resources, improving our knowledge and strategies regarding our education skills may not seem that important. …

The New Demands of Acute Care: Are We Ready?

Physical therapy practitioners in the acute care world have a challenge. The segment of the US population aged 65 years and older is projected to increase from 35 million in 2000 to an estimated 71 million in 2030.1 Incorporated into this demographic bulge is a substantial projected increase in the number of people aged 80 years and older, from 9.3 million in 2000 to 19.5 million in 2030.1 An aging population combined with a longer life expectancy will increase the prevalence of chronic diseases and conditions associated with aging, leading to increased hospitalizations and need for rehabilitation services.2 A frail, increasingly dependent population will place enormous strain on health care providers. Are physical therapists and physical therapist assistants who work in acute care prepared for this challenge? Do we have sufficiently streamlined, efficient work processes? Do therapists have the necessary skills? Do we have the staffing? In this issue of PTJ , 2 articles offer unique insights into acute care physical therapy and should be harbingers of continued dialogue and research. In “Development of a Unique Triage System for Acute Care Physical Therapy and Occupational Therapy Services: An Administrative Case Report,” Hobbs …

Do As I Do: Exercise Habits of Physical Therapists, Physical Therapist Assistants, and Student Physical Therapists

Physical therapy practitioners are among the many health care professionals who can counsel their patients to address the public health care concern of physical inactivity. Health care providers who are physically active themselves are more likely to counsel patients on the benefits of activity. The purposes of this study were: (1) to examine the leisure-time physical activity habits of physical therapists, physical therapist assistants, and student physical therapists in the United States using Centers for Disease Control and Prevention and American College of Sports Medicine (CDC-ACSM) recommendations and (2) to compare these habits with those of the general population and other health care professionals. A cross-sectional survey design was used. There were 2 data sources. A random sample of American Physical Therapy Association members completed an online survey that included questions about physical activity habits worded in same manner as the leisure-time activities section of the 2005 National Health Interview Survey (NHIS). The final study sample comprised 1,238 participants: 923 physical therapists, 210 student physical therapists, and 105 physical therapist assistants. The 2005 NHIS public use data files were the source for the same information about the general US population and for a subset of health care professionals. Rates of participation in vigorous and moderate physical activity were analyzed. Physical therapists, physical therapist assistants, and student physical therapists exercised at higher rates than adults and health-diagnosing professionals in the 2005 NHIS. Limitations The study may be limited by sampling and response bias. This study identified that physical therapists, physical therapist assistants, and student physical therapists are meeting CDC-ACSM physical activity guidelines at higher rates than the US adult population and health-diagnosing professionals. These rates exceed the physical activity targets set for adults in Healthy People 2010.

The Revised APTA Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant: Theory, Purpose, Process, and Significance

In June 2009, the House of Delegates (HOD) of the American Physical Therapy Association (APTA) passed a major revision of the APTA Code of Ethics for physical therapists and the Standards of Ethical Conduct for the Physical Therapist Assistant. The revised documents will be effective July 1, 2010. The purposes of this article are: (1) to provide a historical, professional, and theoretical context for this important revision; (2) to describe the 4-year revision process; (3) to examine major features of the documents; and (4) to discuss the significance of the revisions from the perspective of the maturation of physical therapy as a doctoring profession. PROCESS OF REVISION: The process for revision is delineated within the context of history and the Bylaws of APTA. FORMAT, STRUCTURE, AND CONTENT OF REVISED CORE ETHICS DOCUMENTS: The revised documents represent a significant change in format, level of detail, and scope of application. Previous APTA Codes of Ethics and Standards of Ethical Conduct for the Physical Therapist Assistant have delineated very broad general principles, with specific obligations spelled out in the Ethics and Judicial Committee's Guide for Professional Conduct and Guide for Conduct of the Physical Therapist Assistant. In contrast to the current documents, the revised documents address all 5 roles of the physical therapist, delineate ethical obligations in organizational and business contexts, and align with the tenets of Vision 2020. The significance of this revision is discussed within historical parameters, the implications for physical therapists and physical therapist assistants, the maturation of the profession, societal accountability and moral community, potential regulatory implications, and the inclusive and deliberative process of moral dialogue by which changes were developed, revised, and approved.

BOOK REVIEWS

BOOK REVIEWS

Education Program and Student Characteristics Associated With Pass Rates on the National Physical Therapy Examination for Physical Therapist Assistants

Education Program and Student Characteristics Associated With Pass Rates on the National Physical Therapy Examination for Physical Therapist Assistants

Neonatal Physical Therapy. Part I: Clinical Competencies and Neonatal Intensive Care Unit Clinical Training Models

To describe clinical training models, delineate clinical competencies, and outline a clinical decision-making algorithm for neonatal physical therapy. In these updated practice guidelines, advanced clinical training models, including precepted practicum and residency or fellowship training, are presented to guide practitioners in organizing mentored, competency-based preparation for neonatal care. Clinical competencies in neonatal physical therapy are outlined with advanced clinical proficiencies and knowledge areas specific to each role. An algorithm for decision making on examination, evaluation, intervention, and re-examination processes provides a framework for clinical reasoning. Because of advanced-level competency requirements and the continuous examination, evaluation, and modification of procedures during each patient contact, the intensive care unit is a restricted practice area for physical therapist assistants, physical therapist generalists, and physical therapy students. Accountable, ethical physical therapy for neonates requires advanced, competency-based training with a preceptor in the pediatric subspecialty of neonatology.

Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes.

Little is known about organizational and service delivery factors related to quality of care in physical therapy. This study sought to identify characteristics related to differences in practice outcomes and service utilization. The sample comprised 114 outpatient clinics and 1,058 therapists who treated 16,281 patients with low back pain syndromes during the period 2000-2001. Clinics participated with the Focus on Therapeutic Outcomes, Inc (FOTO) database. Hierarchical linear models were used to risk adjust treatment outcomes and number of visits per treatment episode. Aggregated residual scores from these models were used to classify each clinic into 1 of 3 categories in each of 3 types of performance groups: (1) effectiveness, (2) utilization, and (3) overall performance (ie, composite measure of effectiveness and utilization). Relationships between clinic classification and the following independent variables were examined by multinomial logistic regression: years of therapist experience, number of physical therapists, ratio of physical therapists to physical therapist assistants, proportion of patients with low back pain syndromes, number of new patients per physical therapist per month, utilization of physical therapist assistants, and setting. Clinics that were lower utilizers of physical therapist assistants were 6.6 times more likely to be classified into the high effectiveness group compared with the low effectiveness group, 6.7 times more likely to be classified in the low utilization group compared with the high utilization group, and 12.4 times more likely to be classified in the best performance group compared with the worst performance group. Serving a higher proportion of patients with low back pain syndromes was associated with an increased likelihood of being classified in the lowest or middle group. Years of physical therapist experience was inversely associated with being classified in the middle utilization group compared with the highest utilization group. These findings suggest that, in the treatment of patients with low back pain syndromes, clinics that are low utilizers of physical therapist assistants are more likely to provide superior care (ie, better patient outcomes and lower service use).

Test-Retest Reliability and Minimal Detectable Change of Gait Speed in Individuals Undergoing Rehabilitation After Stroke

Gait speed is commonly used to assess walking ability in persons with stroke. Previous research related to the psychometric properties of gait speed has been conducted primarily with individuals who were able to walk independently and/or were in the later stages of recovery after stroke. The purpose of this research was to examine the test-retest reliability and minimal detectable change (MDC90) of gait speed in individuals with stroke who required varying levels of assistance to ambulate during rehabilitation. Patients who could ambulate with or without physical assistance and were undergoing inpatient rehabilitation were recruited. Gait speed was measured over the middle five meters of a nine-meter walk at a comfortable pace. Data were analyzed using the intraclass correlation coefficient (ICC2,1) and the MDC90. Thirty-five patients who were a mean 34.5 (standard deviation = 17.7) days post-stroke agreed to participate. For all the subjects combined, the ICC2,1 was 0.862 and MDC90 was 0.30 m/sec. For the 13 subjects who required physical assistance to walk, the ICC2,1 = 0.971 and MDC90 = 0.07 m/sec. For the 22 subjects who could walk without physical assistance, the ICC2,1 = 0.80 and MDC90 = 0.36 m/sec. Gait speed is a reliable measure of walking ability for a wide variety of patients undergoing rehabilitation after stroke. Gait speed is more sensitive to change in patients who require physical assistance to walk than in those who can walk without assistance. A change of more than 0.30 m/sec may be necessary in order to determine whether a change in gait speed exceeds measurement error and patient variability.

Intraprofessional Fieldwork Education: Occupational Therapy and Occupational Therapist Assistant Students Learning Together

In the past 10 years, the use of support personnel in Canada has generated significant interest from occupational therapists, professional associations, regulatory bodies, employers, educational institutions, and government agencies. The purpose of this study was to explore the impact of a combined collaborative fieldwork placement and weekly tutorial as a teaching strategy for intraprofessional education. Seven pairs of student occupational therapists and occupational therapist assistants were assigned to fieldwork placements. Tutorials were scheduled during the placements to discuss intraprofessional issues and provision of occupational therapy services in the clinical setting. Journaling and focus groups were used to collect data from students, tutors, and preceptors. Three key themes emerged from the data: (1) developing the relationship, (2) understanding roles, and (3) recognizing environmental influences on learning. Intraprofessional learning experiences prior to graduation can help prepare occupational therapy and occupational therapist assistant students for future collaborative practice.