Shana E Harrington, M Wilson Christopher, Margaret E Rinehart-Ayres, Frances Westlake, Lisa VanHoose
Objective: The objective was to establish consensus-based competencies for oncology within physical therapist professional education programs in the United States.
Methods: A mixed-methods approach implementing a sequential exploratory design that included 3 phases was used to establish oncology competencies for physical therapist professional education programs. Participants in each phase were physical therapists representing diverse practice settings, experience levels, and geographical regions. Student physical therapists were included in phases 2 and 3. Three online focus groups were followed by an in-person group discussion to establish cancer-related themes, domains of practice, and competencies. Participants evaluated the competencies in a 3-round modified Delphi study for relevance and clarity. Each competency required 80% consensus using a Likert scale (1 = not at all relevant/clear, 5 = extremely relevant/clear). It was not accepted if a competency did not meet the 80% threshold by the end of round 3.
Results: Six domains of practice and 28 competencies were developed and evaluated. Within the 6 domains, 21 competencies were accepted: general cancer concepts (n = 4), musculoskeletal system (n = 3), neurologic system (n = 5), integumentary system (n = 2), cardiovascular and pulmonary system (n = 5), and involvement of multiple systems across the lifespan (n = 2). Along with the 21 competencies, participants also recommended 11 overarching oncology themes to incorporate into physical therapist professional education programs. Delivering cancer content using a body systems approach was recommended.
Conclusion: As the number of survivors of cancer continues to grow, integration of these essential competencies within physical therapist professional education programs will improve the profession's capacity to provide quality care to meet the societal need of persons living with and beyond cancer.
Impact: Academic and clinical educators should integrate these competencies to ensure that physical therapist professional education programs appropriately prepare physical therapists for providing care for persons living with and beyond cancer across the lifespan.
{"title":"Essential Competencies for Oncology in Physical Therapist Professional Education Programs: Results of a Mixed Methods Modified Delphi Study.","authors":"Shana E Harrington, M Wilson Christopher, Margaret E Rinehart-Ayres, Frances Westlake, Lisa VanHoose","doi":"10.1093/ptj/pzae146","DOIUrl":"https://doi.org/10.1093/ptj/pzae146","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to establish consensus-based competencies for oncology within physical therapist professional education programs in the United States.</p><p><strong>Methods: </strong>A mixed-methods approach implementing a sequential exploratory design that included 3 phases was used to establish oncology competencies for physical therapist professional education programs. Participants in each phase were physical therapists representing diverse practice settings, experience levels, and geographical regions. Student physical therapists were included in phases 2 and 3. Three online focus groups were followed by an in-person group discussion to establish cancer-related themes, domains of practice, and competencies. Participants evaluated the competencies in a 3-round modified Delphi study for relevance and clarity. Each competency required 80% consensus using a Likert scale (1 = not at all relevant/clear, 5 = extremely relevant/clear). It was not accepted if a competency did not meet the 80% threshold by the end of round 3.</p><p><strong>Results: </strong>Six domains of practice and 28 competencies were developed and evaluated. Within the 6 domains, 21 competencies were accepted: general cancer concepts (n = 4), musculoskeletal system (n = 3), neurologic system (n = 5), integumentary system (n = 2), cardiovascular and pulmonary system (n = 5), and involvement of multiple systems across the lifespan (n = 2). Along with the 21 competencies, participants also recommended 11 overarching oncology themes to incorporate into physical therapist professional education programs. Delivering cancer content using a body systems approach was recommended.</p><p><strong>Conclusion: </strong>As the number of survivors of cancer continues to grow, integration of these essential competencies within physical therapist professional education programs will improve the profession's capacity to provide quality care to meet the societal need of persons living with and beyond cancer.</p><p><strong>Impact: </strong>Academic and clinical educators should integrate these competencies to ensure that physical therapist professional education programs appropriately prepare physical therapists for providing care for persons living with and beyond cancer across the lifespan.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lynn Boswell, Lars Adde, Toril Fjørtoft, Aurelie Pascal, Annemarie Russow, Ragnhild Støen, Niranjan Thomas, Christine Van den Broeck, Raye-Ann de Regnier
Objective: The objective of this study was to investigate the influences on motor development in infants who are at low risk from Belgium, India, Norway, and the United States using the General Movement Assessment at 10-16 weeks postterm age.
Methods: This was a cross-sectional study of prospectively enrolled full-term infants at low risk (n = 186). Certified General Movement Assessment observers rated the fidgety movements, quality of the movement patterns, age-adequacy of the movement repertoire, postural patterns, movement character, and overall Motor Optimality Score-Revised (MOS-R). Scores were evaluated for associations with sex, birth weight category, gestational age, postterm age at video, and country.
Results: The majority of infants had normal fidgety movements (179/186, 96.2%). This did not vary by sex, birth weight, gestational age, postterm age at video, or country. All infants showed normal>atypical movement patterns. Variability was seen for age adequacy (optimal: 137/183, 74.9%), postural patterns (normal>atypical: 164/183, 89.6%), and smooth/ fluent movement character (138/183, 75.4%). Gestational age and postterm age at video were associated with atypical postural patterns, but in multivariable regression, only younger postterm age retained significance (OR = 2.94, 95% CI = 1.05-8.24). Lack of age adequacy was associated with postterm age (OR = 13.15, 95% CI = 4.36-39.72) and country (compared with Norway; Belgium OR = 3.38 95% CI = 12.4-9.22; India OR = 3.16, 95% CI = 1.01-9.87; United States not significant). Infants from India also showed lower rates of an optimal MOS-R (25-28) than infants from Norway.
Conclusion: The normality and temporal organization of fidgety movements did not differ by sex, birth weight, postterm age, or country, suggesting that the fidgety movements are free of cultural and environmental influences. The majority of full-term infants who were healthy in this cohort showed normal scores for all aspects of motor development tested using the MOS-R. Differences in age adequacy and MOS-R by country warrant investigation with larger cohorts and longitudinal follow-up.
Impact: Understanding variations in typical motor development is essential to interpreting patterns of movement and posture in infants at risk for atypical development. Using the framework of Prechtl's General Movement Assessment, this study showed that the development of movement and posture in healthy infants was affected by age and country of birth, but the development of the fidgety movements appeared to be free of these influences. Local norms may be needed to interpret the Motor Optimality Score-Revised in all populations, but further research on this topic is needed.
{"title":"Development of Movement and Postural Patterns in Full-Term Infants Who Are at Low Risk in Belgium, India, Norway, and the United States.","authors":"Lynn Boswell, Lars Adde, Toril Fjørtoft, Aurelie Pascal, Annemarie Russow, Ragnhild Støen, Niranjan Thomas, Christine Van den Broeck, Raye-Ann de Regnier","doi":"10.1093/ptj/pzae081","DOIUrl":"10.1093/ptj/pzae081","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to investigate the influences on motor development in infants who are at low risk from Belgium, India, Norway, and the United States using the General Movement Assessment at 10-16 weeks postterm age.</p><p><strong>Methods: </strong>This was a cross-sectional study of prospectively enrolled full-term infants at low risk (n = 186). Certified General Movement Assessment observers rated the fidgety movements, quality of the movement patterns, age-adequacy of the movement repertoire, postural patterns, movement character, and overall Motor Optimality Score-Revised (MOS-R). Scores were evaluated for associations with sex, birth weight category, gestational age, postterm age at video, and country.</p><p><strong>Results: </strong>The majority of infants had normal fidgety movements (179/186, 96.2%). This did not vary by sex, birth weight, gestational age, postterm age at video, or country. All infants showed normal>atypical movement patterns. Variability was seen for age adequacy (optimal: 137/183, 74.9%), postural patterns (normal>atypical: 164/183, 89.6%), and smooth/ fluent movement character (138/183, 75.4%). Gestational age and postterm age at video were associated with atypical postural patterns, but in multivariable regression, only younger postterm age retained significance (OR = 2.94, 95% CI = 1.05-8.24). Lack of age adequacy was associated with postterm age (OR = 13.15, 95% CI = 4.36-39.72) and country (compared with Norway; Belgium OR = 3.38 95% CI = 12.4-9.22; India OR = 3.16, 95% CI = 1.01-9.87; United States not significant). Infants from India also showed lower rates of an optimal MOS-R (25-28) than infants from Norway.</p><p><strong>Conclusion: </strong>The normality and temporal organization of fidgety movements did not differ by sex, birth weight, postterm age, or country, suggesting that the fidgety movements are free of cultural and environmental influences. The majority of full-term infants who were healthy in this cohort showed normal scores for all aspects of motor development tested using the MOS-R. Differences in age adequacy and MOS-R by country warrant investigation with larger cohorts and longitudinal follow-up.</p><p><strong>Impact: </strong>Understanding variations in typical motor development is essential to interpreting patterns of movement and posture in infants at risk for atypical development. Using the framework of Prechtl's General Movement Assessment, this study showed that the development of movement and posture in healthy infants was affected by age and country of birth, but the development of the fidgety movements appeared to be free of these influences. Local norms may be needed to interpret the Motor Optimality Score-Revised in all populations, but further research on this topic is needed.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John M Mayer, Michael Jason Highsmith, Jason Maikos, Charity G Patterson, Joseph Kakyomya, Bridget Smith, Nigel Shenoy, Christopher L Dearth, Shawn Farrokhi
Objective: The objective of this study was to examine the associations between active, passive, and manual therapy interventions with the escalation-of-care events following physical therapist care for veterans with low back pain (LBP).
Methods: A retrospective cohort study was conducted in 3618 veterans who received physical therapist care for LBP between January 1, 2015 and January 1, 2018. The Department of Veterans Affairs (VA) Corporate Data Warehouse was utilized to identify LBP-related physical therapist visits and procedures, as well as opioid prescription and non-physical therapy clinic encounters. The association between physical therapist interventions with 1-year escalation-of-care events were assessed using adjusted odds ratios from logistic regression.
Results: Nearly all veterans (98%) received active interventions, but only a minority (31%) received manual therapy. In the 1-year follow-up period, the odds of receiving an opioid prescription were 30% lower for those who received manual therapy in addition to active interventions, as compared with patients who received only active interventions. Moreover, the odds of receiving primary care, specialty care, and diagnostic testing were 30% to 130% higher for patients who received electrical stimulation or more than 1 passive intervention in addition to active treatments, as compared with patients who received only active interventions.
Conclusion: The use of manual therapy along with active interventions was associated with reduced prescription of opioids, while utilization of specific passive interventions such as electrical stimulation or multiple modalities in conjunction with active interventions resulted in increased escalation-of-care events.
Impact: The use of active interventions, which is supported by most clinical practice guidelines, was the cornerstone of physical therapist care for veterans with LBP. However, the use of clinical practice guideline-recommended manual therapy interventions was low but associated with reduced opioid prescriptions. The use of 2 or more different passive interventions along with active interventions was common (34%) and associated with less-than-optimal escalation-of-care outcomes.
{"title":"The Influence of Active, Passive, and Manual Therapy Interventions on Escalation of Health Care Events After Physical Therapist Care in Veterans With Low Back Pain.","authors":"John M Mayer, Michael Jason Highsmith, Jason Maikos, Charity G Patterson, Joseph Kakyomya, Bridget Smith, Nigel Shenoy, Christopher L Dearth, Shawn Farrokhi","doi":"10.1093/ptj/pzae101","DOIUrl":"10.1093/ptj/pzae101","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to examine the associations between active, passive, and manual therapy interventions with the escalation-of-care events following physical therapist care for veterans with low back pain (LBP).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in 3618 veterans who received physical therapist care for LBP between January 1, 2015 and January 1, 2018. The Department of Veterans Affairs (VA) Corporate Data Warehouse was utilized to identify LBP-related physical therapist visits and procedures, as well as opioid prescription and non-physical therapy clinic encounters. The association between physical therapist interventions with 1-year escalation-of-care events were assessed using adjusted odds ratios from logistic regression.</p><p><strong>Results: </strong>Nearly all veterans (98%) received active interventions, but only a minority (31%) received manual therapy. In the 1-year follow-up period, the odds of receiving an opioid prescription were 30% lower for those who received manual therapy in addition to active interventions, as compared with patients who received only active interventions. Moreover, the odds of receiving primary care, specialty care, and diagnostic testing were 30% to 130% higher for patients who received electrical stimulation or more than 1 passive intervention in addition to active treatments, as compared with patients who received only active interventions.</p><p><strong>Conclusion: </strong>The use of manual therapy along with active interventions was associated with reduced prescription of opioids, while utilization of specific passive interventions such as electrical stimulation or multiple modalities in conjunction with active interventions resulted in increased escalation-of-care events.</p><p><strong>Impact: </strong>The use of active interventions, which is supported by most clinical practice guidelines, was the cornerstone of physical therapist care for veterans with LBP. However, the use of clinical practice guideline-recommended manual therapy interventions was low but associated with reduced opioid prescriptions. The use of 2 or more different passive interventions along with active interventions was common (34%) and associated with less-than-optimal escalation-of-care outcomes.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Following an injury or disease, physical medicine and rehabilitation (PM&R) services are often necessary to help patients recover function, activity, and community participation. Ten years ago, there was a significant gap between PM&R services in central Israel and those in the rural north of the country in terms of quality, quantity, and layout. The purpose of this administrative case report is to outline the gap in PM&R services between regions in Israel, as portrayed above; to describe a decade of civil action; and to describe civil action administrative approaches and actions that contributed to changes in the PM&R services now available in northern Israel.
Methods: A decade of civil action to promote PM&R services is reviewed, illustrating the main administrative steps, including initiating and organizing meetings with key partners, lobbying, testifying in front of parliament and government committees, garnering media attention to promote public awareness, and filing a case with the Supreme Court of Israel. The encountered challenges and the subsequent actions are also described.
Results: Awareness of the significance of PM&R services and of the inadequacy of such services in the northern part of Israel rose due to our actions, with practical field results, including a 180-bed government rehabilitation center that plans to open during 2024, and 5 daycare rehabilitation clinics and a private inpatient center that opened between 2020 and 2023. Data-driven research will aid in understanding the current gaps and tracking improvements with the opening of the new rehabilitation facility.
Conclusion: When inequality is brought to light and legislation for equality exists, civil action can promote change to reduce these gaps.
Impact: Others can follow the steps taken in this administrative case report to achieve success in struggles aiming to correct comparative inequality.
{"title":"Geographic Inequity in Physical Medicine and Rehabilitation Services: An Administrative Case Report of Successful Advocacy for Change.","authors":"Hadas Ofek, Mohammad Khatib, Katherin Joubran","doi":"10.1093/ptj/pzae109","DOIUrl":"10.1093/ptj/pzae109","url":null,"abstract":"<p><strong>Objective: </strong>Following an injury or disease, physical medicine and rehabilitation (PM&R) services are often necessary to help patients recover function, activity, and community participation. Ten years ago, there was a significant gap between PM&R services in central Israel and those in the rural north of the country in terms of quality, quantity, and layout. The purpose of this administrative case report is to outline the gap in PM&R services between regions in Israel, as portrayed above; to describe a decade of civil action; and to describe civil action administrative approaches and actions that contributed to changes in the PM&R services now available in northern Israel.</p><p><strong>Methods: </strong>A decade of civil action to promote PM&R services is reviewed, illustrating the main administrative steps, including initiating and organizing meetings with key partners, lobbying, testifying in front of parliament and government committees, garnering media attention to promote public awareness, and filing a case with the Supreme Court of Israel. The encountered challenges and the subsequent actions are also described.</p><p><strong>Results: </strong>Awareness of the significance of PM&R services and of the inadequacy of such services in the northern part of Israel rose due to our actions, with practical field results, including a 180-bed government rehabilitation center that plans to open during 2024, and 5 daycare rehabilitation clinics and a private inpatient center that opened between 2020 and 2023. Data-driven research will aid in understanding the current gaps and tracking improvements with the opening of the new rehabilitation facility.</p><p><strong>Conclusion: </strong>When inequality is brought to light and legislation for equality exists, civil action can promote change to reduce these gaps.</p><p><strong>Impact: </strong>Others can follow the steps taken in this administrative case report to achieve success in struggles aiming to correct comparative inequality.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Community Mobility Among Older Adults Who Are Socioeconomically Disadvantaged: Addressing the Poverty Penalty.","authors":"Erica Twardzik, Jack M Guralnik, Jason R Falvey","doi":"10.1093/ptj/pzad182","DOIUrl":"10.1093/ptj/pzad182","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139074778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maureen Romanow Pascal, Barbara Lawrence, Stephanie Pires, Elton Newton, Deoranie Babulall, Kelly Saroka, Megan Shaver, Mackenzie Schanzlin, Kristi Pearage
Objective: The objective was to describe the social, environmental, and cultural adaptations to an existing falls program and assess acceptability and preliminary effectiveness of the program in reducing fear, reducing falls, and improving function among individuals poststroke in Guyana.
Methods: A quasi-experimental pilot study with a pretest/posttest in-group design was developed through a collaboration of researchers in Guyana and the US. Participants took part in the falls prevention program for 8 weeks. Outcome measures included a 10-m walk test, the Five Times Sit to Stand Test, and subjective questionnaires for falls incidence and balance confidence at the beginning and end.
Results: Twenty participants completed the study. One participant experienced medical complications, and their data were excluded from analysis. Fifteen participants (78.9%) demonstrated improvements in comfortable and fast walking speed. Twelve participants completed the Five Times Sit to Stand Test. Eleven (91.67%) improved their time at the posttest, with 9 (81.8%) demonstrating a clinically important improvement. Nineteen participants had sustained at least 1 fall prior to the study. Only 1 participant reported a fall during the program. Initially, the majority of participants (11/19) were very concerned about falling. At the end, only 1 was very concerned about falling, and the majority (15/19) were not concerned at all. Posttest surveys of participants indicated acceptability of the program.
Conclusions: This pilot program helped reduce fall risk and improve confidence, gait speed, and community mobility of the study participants. Future research at other rehabilitation departments in Guyana would help increase the generalizability of the program.
Impact: The program can be used clinically by physical therapists in Guyana, both in departments and as a home program. Shared knowledge and experience of researchers considering research evidence and the environmental, social, and economic conditions of people living in Guyana were important in developing an effective program.
{"title":"A Falls Prevention Program for People After Stroke in Guyana: An International Collaboration.","authors":"Maureen Romanow Pascal, Barbara Lawrence, Stephanie Pires, Elton Newton, Deoranie Babulall, Kelly Saroka, Megan Shaver, Mackenzie Schanzlin, Kristi Pearage","doi":"10.1093/ptj/pzae107","DOIUrl":"10.1093/ptj/pzae107","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to describe the social, environmental, and cultural adaptations to an existing falls program and assess acceptability and preliminary effectiveness of the program in reducing fear, reducing falls, and improving function among individuals poststroke in Guyana.</p><p><strong>Methods: </strong>A quasi-experimental pilot study with a pretest/posttest in-group design was developed through a collaboration of researchers in Guyana and the US. Participants took part in the falls prevention program for 8 weeks. Outcome measures included a 10-m walk test, the Five Times Sit to Stand Test, and subjective questionnaires for falls incidence and balance confidence at the beginning and end.</p><p><strong>Results: </strong>Twenty participants completed the study. One participant experienced medical complications, and their data were excluded from analysis. Fifteen participants (78.9%) demonstrated improvements in comfortable and fast walking speed. Twelve participants completed the Five Times Sit to Stand Test. Eleven (91.67%) improved their time at the posttest, with 9 (81.8%) demonstrating a clinically important improvement. Nineteen participants had sustained at least 1 fall prior to the study. Only 1 participant reported a fall during the program. Initially, the majority of participants (11/19) were very concerned about falling. At the end, only 1 was very concerned about falling, and the majority (15/19) were not concerned at all. Posttest surveys of participants indicated acceptability of the program.</p><p><strong>Conclusions: </strong>This pilot program helped reduce fall risk and improve confidence, gait speed, and community mobility of the study participants. Future research at other rehabilitation departments in Guyana would help increase the generalizability of the program.</p><p><strong>Impact: </strong>The program can be used clinically by physical therapists in Guyana, both in departments and as a home program. Shared knowledge and experience of researchers considering research evidence and the environmental, social, and economic conditions of people living in Guyana were important in developing an effective program.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Allyn Bove, Bayan Aldhahwani, Rose Turner, Sean Repage, Parker Denny, Cynthia Brand, Kaitlyn Sweeney, Sam Allison, Heather Ross, Kelli D Allen, Jared W Magnani, Lauren Terhorst, Anthony Delitto, Janet Freburger
Objective: The aims of this scoping review were to summarize the evidence regarding sex, racial, ethnic, geographic, and socioeconomic disparities in post-acute rehabilitation following total hip arthroplasty (THA) and knee arthroplasty (TKA).
Methods: Literature searches were conducted in Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and PEDro. Studies were included if they were original research articles published 1993 or later; used data from the US; included patients after THA and/or TKA; presented results according to relevant sociodemographic variables, including sex, race, ethnicity, geography, or socioeconomic status; and studied the utilization of post-acute rehabilitation as an outcome.
Results: Twelve studies met the inclusion criteria. Five examined disparities in inpatient rehabilitation and found that Black patients and women experience longer lengths of stay after arthroplasty, and women are less likely than men to be discharged home after inpatient THA rehabilitation. Four studies examined data from skilled nursing facilities and found that insurance type and dual eligibility impact length of stay and rates of community discharge but found conflicting results regarding racial disparities in skilled nursing facility utilization after TKA. Five studies examined home health data and noted that rural agencies provide less care after TKA. Results regarding racial disparities in home health utilization after arthroplasty were conflicting. Six studies of outpatient rehabilitation noted geographic differences in timing of outpatient rehabilitation but mixed results regarding race differences in outpatient rehabilitation.
Conclusion: Current evidence indicates that sex, race, ethnicity, geography, and socioeconomic status are associated with disparities in postacute rehabilitation use after arthroplasty.
Impact: Rehabilitation providers across the postacute continuum should be aware of disparities in the population of patients after arthroplasty and regularly assess social determinants of health and other factors that may contribute to disparities. Customized care plans should ensure optimal timing and amount of rehabilitation is provided, and advocate for patients who need additional care to achieve the desired functional outcome.
目的本范围综述旨在总结有关全髋关节置换术(THA)和膝关节置换术(TKA)术后康复的性别、种族、民族、地域和社会经济差异的证据:在 Ovid MEDLINE、EMBASE、CINAHL、Web of Science 和 PEDro 中进行文献检索。纳入的研究必须是1993年或之后发表的原创研究文章;使用的数据来自美国;纳入了THA和/或TKA术后患者;根据相关社会人口变量(包括性别、种族、民族、地域或社会经济状况)展示了研究结果;并将急性期后康复的使用情况作为研究结果之一:结果:12 项研究符合纳入标准。其中五项研究调查了住院康复治疗中的差异,发现黑人患者和女性患者在关节置换术后住院时间更长,而且女性在THA住院康复治疗后出院回家的可能性低于男性。四项研究检查了专业护理机构的数据,发现保险类型和双重资格对住院时间和社区出院率有影响,但在 TKA 术后专业护理机构利用率的种族差异方面发现了相互矛盾的结果。五项研究检查了家庭医疗数据,并指出农村机构在 TKA 术后提供的护理较少。关于关节置换术后家庭医疗利用率的种族差异,研究结果相互矛盾。六项关于门诊康复的研究指出了门诊康复时间的地域差异,但关于门诊康复的种族差异的结果不一:目前的证据表明,性别、种族、民族、地域和社会经济地位与关节置换术后急性期康复使用的差异有关:影响:整个急性期后康复服务的提供者都应意识到关节置换术后患者群体中存在的差异,并定期评估健康的社会决定因素和其他可能导致差异的因素。定制的护理计划应确保提供最佳的康复时间和康复量,并为需要额外护理的患者提供支持,以达到预期的功能效果。
{"title":"Beyond Discharge Disposition: A Scoping Review on Sociodemographic Disparities in Rehabilitation Use After Hip and Knee Arthroplasty.","authors":"Allyn Bove, Bayan Aldhahwani, Rose Turner, Sean Repage, Parker Denny, Cynthia Brand, Kaitlyn Sweeney, Sam Allison, Heather Ross, Kelli D Allen, Jared W Magnani, Lauren Terhorst, Anthony Delitto, Janet Freburger","doi":"10.1093/ptj/pzae074","DOIUrl":"10.1093/ptj/pzae074","url":null,"abstract":"<p><strong>Objective: </strong>The aims of this scoping review were to summarize the evidence regarding sex, racial, ethnic, geographic, and socioeconomic disparities in post-acute rehabilitation following total hip arthroplasty (THA) and knee arthroplasty (TKA).</p><p><strong>Methods: </strong>Literature searches were conducted in Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and PEDro. Studies were included if they were original research articles published 1993 or later; used data from the US; included patients after THA and/or TKA; presented results according to relevant sociodemographic variables, including sex, race, ethnicity, geography, or socioeconomic status; and studied the utilization of post-acute rehabilitation as an outcome.</p><p><strong>Results: </strong>Twelve studies met the inclusion criteria. Five examined disparities in inpatient rehabilitation and found that Black patients and women experience longer lengths of stay after arthroplasty, and women are less likely than men to be discharged home after inpatient THA rehabilitation. Four studies examined data from skilled nursing facilities and found that insurance type and dual eligibility impact length of stay and rates of community discharge but found conflicting results regarding racial disparities in skilled nursing facility utilization after TKA. Five studies examined home health data and noted that rural agencies provide less care after TKA. Results regarding racial disparities in home health utilization after arthroplasty were conflicting. Six studies of outpatient rehabilitation noted geographic differences in timing of outpatient rehabilitation but mixed results regarding race differences in outpatient rehabilitation.</p><p><strong>Conclusion: </strong>Current evidence indicates that sex, race, ethnicity, geography, and socioeconomic status are associated with disparities in postacute rehabilitation use after arthroplasty.</p><p><strong>Impact: </strong>Rehabilitation providers across the postacute continuum should be aware of disparities in the population of patients after arthroplasty and regularly assess social determinants of health and other factors that may contribute to disparities. Customized care plans should ensure optimal timing and amount of rehabilitation is provided, and advocate for patients who need additional care to achieve the desired functional outcome.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brooke N Klatt, Subashan Perera, Pamela M Dunlap, Andrea L Rosso, Jennifer S Brach
Objective: Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1 year in community dwelling older adults.
Methods: A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated.
Results: For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99).
Conclusion: Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions.
Impact statement: Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized.
Lay summary: Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.
目的:活动和参与对老年人非常重要,因为它们与老年人的福祉和生活质量息息相关。跌倒、急诊室就诊和住院是影响老年人健康的不良后果。对于活动和参与的测量是否与居住在社区的老年人的不良健康事件有关,研究有限。本研究旨在探讨社区老年人一年内活动和参与与跌倒、急诊就诊和住院之间的关系:对 341 名社区老年人的纵向临床试验进行了二次分析。样本的平均年龄为 80.9 岁(SD = 7.7),83% 为女性。一年的跌倒风险与晚年功能和残疾指数(LLFDI)中的总体功能和残疾(频率和限制)基线相关。计算出了发病率比(IRRs)和 95% CIs:根据 LLFDI 整体功能(已对年龄、种族、性别、合并症和跌倒史进行调整)衡量的活动得分每提高 5 分(临床意义差异),跌倒率降低 18%(IRR = 0.82,95% CI = 0.74-0.92);住院率降低 12%(IRR = 0.88;95% CI = 0.77-0.99);急诊就诊率降低 11%(IRR = 0.89,95% CI = 0.81-0.98)。以 LLFDI 限制维度衡量的更多参与与更少的跌倒(IRR = 0.93,95% CI = 0.87-1.00)和住院(IRR = 0.91,95% CI = 0.83-0.99)有关:结论:更多的活动和参与与较低的跌倒、急诊室就诊和住院率有关,是物理治疗师进行有针对性干预的重要考虑因素:物理治疗师在识别和解决活动和参与减少的问题方面具有独特的优势。如果通过物理治疗有针对性地提高活动和参与度,就可以预防或最大限度地减少不良的远端健康后果。
{"title":"Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults.","authors":"Brooke N Klatt, Subashan Perera, Pamela M Dunlap, Andrea L Rosso, Jennifer S Brach","doi":"10.1093/ptj/pzae087","DOIUrl":"10.1093/ptj/pzae087","url":null,"abstract":"<p><strong>Objective: </strong>Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1 year in community dwelling older adults.</p><p><strong>Methods: </strong>A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated.</p><p><strong>Results: </strong>For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99).</p><p><strong>Conclusion: </strong>Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions.</p><p><strong>Impact statement: </strong>Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized.</p><p><strong>Lay summary: </strong>Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11485024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The objective of this study was to examine the role of pain catastrophizing and pain self-efficacy as possible mediators of race-based differences in pain intensity and to evaluate the possible moderating role of race on the relationship between pain catastrophizing and pain self-efficacy with pain outcomes among persons with chronic spinal pain receiving physical therapy.
Methods: This study was a secondary analysis of a cluster-randomized trial. Participants were persons with chronic spinal pain in outpatient physical therapy clinics who consented to complete assessments at baseline and after 2 weeks and 12 weeks. Assessments included pain intensity, physical function, pain catastrophizing, and self-efficacy. Baseline comparisons between Black and non-Hispanic White participants were made. Mediation analyses used a regression-based framework to examine whether baseline pain catastrophizing and self-efficacy mediated the association between race and pain intensity. Moderation analyses used multiple linear regression to evaluate the role of race in the relationship of baseline pain catastrophizing and self-efficacy with 12-week pain intensity outcomes.
Results: A total of 274 participants were included (51 [18.6%] Black and 223 [81.4%] non-Hispanic White; mean age = 51.6 years [standard deviation = 14.9]; 180 [65.7%] female). At baseline, Black participants had higher pain intensity scores (mean difference = 0.80; 95% CI =1.5 to 0.12). Both pain catastrophizing and self-efficacy mediated the relationship between race and baseline pain intensity. Race moderated the relationships between baseline pain catastrophizing and self-efficacy and 12-week pain intensity scores.
Conclusion: Pain catastrophizing and self-efficacy had differential impacts on pain intensity based on race for both cross-sectional and longitudinal analyses among persons receiving physical therapy for chronic spinal pain.
Impact: Improved understanding of the differences in pain experience based on factors such as race, ethnicity, cultural background, and experience with the health care system may help reduce disparities in pain management.
{"title":"Differences in Pain Experience Among Different Racial and Ethnic Groups.","authors":"Elizabeth Lane, Chris Barnes, Julie M Fritz","doi":"10.1093/ptj/pzae001","DOIUrl":"10.1093/ptj/pzae001","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to examine the role of pain catastrophizing and pain self-efficacy as possible mediators of race-based differences in pain intensity and to evaluate the possible moderating role of race on the relationship between pain catastrophizing and pain self-efficacy with pain outcomes among persons with chronic spinal pain receiving physical therapy.</p><p><strong>Methods: </strong>This study was a secondary analysis of a cluster-randomized trial. Participants were persons with chronic spinal pain in outpatient physical therapy clinics who consented to complete assessments at baseline and after 2 weeks and 12 weeks. Assessments included pain intensity, physical function, pain catastrophizing, and self-efficacy. Baseline comparisons between Black and non-Hispanic White participants were made. Mediation analyses used a regression-based framework to examine whether baseline pain catastrophizing and self-efficacy mediated the association between race and pain intensity. Moderation analyses used multiple linear regression to evaluate the role of race in the relationship of baseline pain catastrophizing and self-efficacy with 12-week pain intensity outcomes.</p><p><strong>Results: </strong>A total of 274 participants were included (51 [18.6%] Black and 223 [81.4%] non-Hispanic White; mean age = 51.6 years [standard deviation = 14.9]; 180 [65.7%] female). At baseline, Black participants had higher pain intensity scores (mean difference = 0.80; 95% CI =1.5 to 0.12). Both pain catastrophizing and self-efficacy mediated the relationship between race and baseline pain intensity. Race moderated the relationships between baseline pain catastrophizing and self-efficacy and 12-week pain intensity scores.</p><p><strong>Conclusion: </strong>Pain catastrophizing and self-efficacy had differential impacts on pain intensity based on race for both cross-sectional and longitudinal analyses among persons receiving physical therapy for chronic spinal pain.</p><p><strong>Impact: </strong>Improved understanding of the differences in pain experience based on factors such as race, ethnicity, cultural background, and experience with the health care system may help reduce disparities in pain management.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139106500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}