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Essential Competencies for Oncology in Physical Therapist Professional Education Programs: Results of a Mixed Methods Modified Delphi Study. 物理治疗师专业教育课程中肿瘤学的基本能力:混合方法修正德尔菲研究的结果。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-07 DOI: 10.1093/ptj/pzae146
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.

目的目的是在美国理疗师专业教育项目中建立基于共识的肿瘤学能力:采用混合方法,实施顺序探索设计,包括三个阶段,为理疗师专业教育项目建立肿瘤学能力。每个阶段的参与者都是代表不同实践环境、经验水平和地理区域的理疗师。学生理疗师也参与了第二和第三阶段。三个在线焦点小组之后进行了一次面对面的小组讨论,以确定与癌症相关的主题、实践领域和能力。参与者通过三轮改良德尔菲研究对能力的相关性和清晰度进行评估。每项能力都需要使用李克特量表达成 80% 的共识(1 = 完全不相关/不清晰,5 = 极其相关/清晰)。如果在第三轮结束时某项能力未达到 80% 的门槛,则不予接受:制定并评估了 6 个实践领域和 28 项能力。在这 6 个领域中,有 21 项能力获得认可:一般癌症概念(n = 4)、肌肉骨骼系统(n = 3)、神经系统(n = 5)、全身系统(n = 2)、心血管和肺部系统(n = 5),以及涉及整个生命周期的多个系统(n = 2)。除了 21 项能力之外,与会者还推荐了 11 个肿瘤学总体主题,以纳入理疗师专业教育计划。与会者还建议采用身体系统方法讲授癌症内容:结论:随着癌症幸存者人数的不断增加,将这些基本能力纳入理疗师专业教育课程将提高理疗师行业提供优质护理的能力,以满足社会对癌症患者和癌症后患者的需求:学术和临床教育者应整合这些能力,以确保理疗师专业教育项目能适当培养理疗师,为癌症患者及癌症后患者提供全生命周期的护理。
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引用次数: 0
Development of Movement and Postural Patterns in Full-Term Infants Who Are at Low Risk in Belgium, India, Norway, and the United States. 比利时、印度、挪威和美国低风险足月婴儿运动和姿势模式的发展。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae081
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.

研究目的本研究的目的是利用一般运动评估(GMA)调查比利时、印度、挪威和美国(US)低风险婴儿在足月后 10-16 周时运动发育的影响因素:这是一项横断面研究,对象是前瞻性登记的足月低风险婴儿(n = 186)。经认证的 GMA 观察员对婴儿的烦躁动作、动作模式的质量、动作剧目的年龄适宜性、姿势模式、动作特征和总体运动优化评分 - 修订版 (MOS-R) 进行评分。对得分与性别、出生体重类别、胎龄、录像时的足月年龄和国家的关系进行了评估:结果:大多数婴儿有正常的烦躁动作(179/186,96.2%)。性别、出生体重、胎龄、录像时的足月年龄和国家均无差异。所有婴儿都表现出正常>典型的运动模式。婴儿的年龄适宜性(最佳:137/183,74.9%)、姿势模式(正常>典型:164/183,89.6%)和平稳/流畅的运动特征(138/183,75.4%)存在差异。录像时的妊娠年龄和足月年龄与非典型姿势模式有关,但在多变量回归中,只有较小的足月年龄具有显著性(OR 2.94,95% CI:1.05-8.24)。缺乏适当年龄与产后年龄(OR 13.15,95% CI:4.36-39.72)和国家(与挪威相比;比利时 OR 3.38,95% CI:12.4-9.22;印度 OR 3.16,95% CI:1.01-9.87:美国差异不大)。印度婴儿的最佳 MOS-R 比率(25-28)也低于挪威婴儿:躁动动作的规范性和时间组织并不因性别、出生体重、足月后年龄或国家而异,这表明躁动动作不受文化和环境的影响。在这批健康的足月婴儿中,大多数在使用 MOS-R 进行的运动发育测试中各方面的得分都正常。不同国家的婴儿在适龄性和 MOS-R 方面的差异值得通过更大范围的队列和纵向随访进行研究:影响声明:了解典型运动发育的变化对于解释有非典型发育风险的婴儿的运动和姿势模式至关重要。本研究采用 Prechtl 一般动作评估框架,显示健康婴儿的动作和姿势发育受年龄和出生国家的影响,但烦躁动作的发育似乎不受这些因素的影响。要在所有人群中解释运动最优性评分-修订版,可能需要当地的标准,但这一课题还需要进一步研究。
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引用次数: 0
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. 主动、被动和徒手治疗干预对退伍军人腰痛理疗后医疗事件升级的影响。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae101
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.

研究目的本研究旨在探讨主动、被动和徒手治疗干预措施与退伍军人腰背痛(LBP)理疗师护理后护理升级事件之间的关联:我们对 2015 年 1 月 1 日至 2018 年 1 月 1 日期间因腰背痛接受理疗师治疗的 3618 名退伍军人进行了回顾性队列研究。研究利用退伍军人事务部企业数据仓库(VA Corporate Data Warehouse)来识别与枸杞多糖相关的理疗师就诊和治疗过程,以及阿片类药物处方和非理疗诊所就诊情况。理疗师干预与 1 年护理升级事件之间的关联采用逻辑回归的调整赔率进行评估:几乎所有退伍军人(98%)都接受了积极干预,但只有少数人(31%)接受了人工疗法。在为期一年的随访期间,与只接受积极干预的患者相比,除了积极干预还接受人工疗法的患者接受阿片类药物处方的几率要低 30%。此外,与只接受主动干预的患者相比,除了接受主动治疗外还接受电刺激或一种以上被动干预的患者接受初级保健、专科护理和诊断检测的几率要高出30%-130%:结论:在主动干预的同时使用手法治疗与阿片类药物处方的减少有关,而在主动干预的同时使用特定的被动干预(如电刺激或多种方式)会导致护理升级事件的增加:大多数《临床实践指南》(CPG)都支持使用主动干预措施,这是物理治疗师为患有腰背痛的退伍军人提供护理的基石。然而,CPG 推荐的徒手治疗干预措施使用率较低,但与阿片类药物处方的减少有关。使用 2 种或 2 种以上不同的被动干预措施和主动干预措施的情况很普遍(34%),而且与护理升级效果不理想有关。
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引用次数: 0
Geographic Inequity in Physical Medicine and Rehabilitation Services: An Administrative Case Report of Successful Advocacy for Change. 物理医学与康复服务中的地域不平等:成功倡导变革的行政案例报告》。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae109
Hadas Ofek, Mohammad Khatib, Katherin Joubran

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.

目的:受伤或患病后,通常需要物理医学与康复(PM&R)服务来帮助患者恢复功能、活动和社区参与。十年前,以色列中部的物理医学与康复服务与北部农村地区的物理医学与康复服务在质量、数量和布局方面存在明显差距。本行政案例报告旨在概述上述以色列各地区之间在 PM&R 服务方面存在的差距;描述十年来的民间行动;并描述促使以色列北部目前 PM&R 服务发生变化的民间行动行政方法和行动:方法:回顾了十年来促进 PM&R 服务的民间行动,说明了主要的行政步骤,包括发起和组织与主要合作伙伴的会议、游说、在议会和政府委员会前作证、吸引媒体关注以提高公众意识,以及向以色列最高法院提起诉讼。还介绍了遇到的挑战和随后采取的行动:结果:由于我们的行动,以色列北部地区对 PM&R 服务的重要性以及此类服务不足的认识有所提高,并取得了实际的实地成果,包括计划于 2024 年开放的拥有 180 张床位的政府康复中心,以及于 2020 年至 2023 年开放的 5 家日托康复诊所和一家私人住院中心。数据驱动的研究将有助于了解当前的差距,并跟踪新康复设施启用后的改善情况:结论:当不平等现象被揭露出来,并且存在促进平等的立法时,公民行动可以推动变革,缩小这些差距:其他人可以效仿本行政案例报告中的步骤,在旨在纠正比较不平等的斗争中取得成功。
{"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}
引用次数: 0
Community Mobility Among Older Adults Who Are Socioeconomically Disadvantaged: Addressing the Poverty Penalty. 社会经济处境不利的老年人的社区流动性:解决贫困惩罚。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzad182
Erica Twardzik, Jack M Guralnik, Jason R Falvey
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引用次数: 0
A Falls Prevention Program for People After Stroke in Guyana: An International Collaboration. 圭亚那中风后预防跌倒计划:国际合作。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae107
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.

目的目的是描述对现有跌倒计划的社会、环境和文化适应性,并评估该计划在减少圭亚那中风后患者的恐惧、减少跌倒和改善功能方面的可接受性和初步有效性:方法:圭亚那和美国的研究人员合作开展了一项准实验性试点研究,采用组内前测/后测设计。参与者参加了为期 8 周的跌倒预防计划。结果测量包括 10 米步行测试、五次坐立测试,以及在开始和结束时对跌倒发生率和平衡信心的主观问卷调查:结果:20 名参与者完成了研究。一名参与者出现医疗并发症,其数据未纳入分析。15名参与者(78.9%)在舒适和快速行走速度方面有所改善。12 名参与者完成了五次坐立测试。有 11 人(91.67%)在测试后的时间上有所改善,其中 9 人(81.8%)的改善具有临床意义。19 名参与者在研究前至少摔倒过一次。只有 1 名参与者报告在课程期间摔倒过。最初,大多数参与者(11/19)都非常担心跌倒。最后,只有 1 人非常担心跌倒,大多数人(15/19)完全不担心。对参与者进行的测试后调查显示,他们对该计划表示接受:该试点项目有助于降低跌倒风险,提高研究参与者的自信心、步态速度和社区活动能力。未来在圭亚那其他康复部门开展的研究将有助于提高该计划的推广性:影响声明:圭亚那的理疗师可以在临床上使用该计划,既可以在科室使用,也可以作为家庭计划使用。考虑到研究证据以及圭亚那居民的环境、社会和经济条件,研究人员共享知识和经验对于制定有效的计划非常重要。
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引用次数: 0
Beyond Discharge Disposition: A Scoping Review on Sociodemographic Disparities in Rehabilitation Use After Hip and Knee Arthroplasty. 超越出院处置:关于髋关节和膝关节置换术后康复治疗使用方面社会人口差异的范围界定综述》(A Scoping Review on Sociodemographic Disparities in Rehabilitation Use after Hip and Knee Arthroplasty)。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae074
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。
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引用次数: 0
My View of PTJ: 10 Months Later…. 我眼中的 PTJ:10 个月之后....
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae150
Steven Z George
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引用次数: 0
Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults. 活动和参与与社区老年人未来的跌倒、住院和急诊就诊有关。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae087
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}
引用次数: 0
Differences in Pain Experience Among Different Racial and Ethnic Groups. 不同种族和族裔群体的疼痛体验差异。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae001
Elizabeth Lane, Chris Barnes, Julie M Fritz

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.

研究目的本研究旨在探讨疼痛灾难化和疼痛自我效能感在疼痛强度种族差异中可能起到的中介作用,并评估种族在疼痛灾难化和疼痛自我效能感与接受物理治疗的慢性脊柱疼痛患者的疼痛结果之间可能起到的调节作用:本研究是对一项分组随机试验的二次分析。参与者为门诊物理治疗诊所的慢性脊柱疼痛患者,他们同意在基线期以及 2 周和 12 周后完成评估。评估内容包括疼痛强度、身体功能、疼痛灾难化和自我效能。对黑人和非西班牙裔白人参与者进行了基线比较。中介分析采用了基于回归的框架,以研究基线疼痛灾难化和自我效能是否对种族和疼痛强度之间的关联起中介作用。调节分析使用多元线性回归来评估种族在基线疼痛灾难化和自我效能与 12 周疼痛强度结果之间的关系:共纳入 274 名参与者(51 名 [18.6%] 黑人和 223 名 [81.4%] 非西班牙裔白人;平均年龄 = 51.6 岁 [SD = 14.9];180 名 [65.7%] 女性)。基线时,黑人参与者的疼痛强度得分更高(平均差异 = 0.80;95% CI = 1.5 至 0.12)。疼痛灾难化和自我效能对种族和基线疼痛强度之间的关系起到了中介作用。种族调节了基线疼痛灾难化和自我效能与12周疼痛强度评分之间的关系:结论:在对接受物理治疗的慢性脊柱疼痛患者进行横断面和纵向分析时,疼痛灾难化和自我效能感对疼痛强度的影响因种族而异:影响:进一步了解基于种族、民族、文化背景和医疗保健系统经验等因素的疼痛体验差异,有助于减少疼痛治疗中的差异。
{"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}
引用次数: 0
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Physical Therapy
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