Physical Therapy最新文献

Objective: To optimize learning in physical therapist education, learners need opportunities to grow from their unique starting points. Traditional grading practices like A to F grades, zero grades, and grading on timeliness and professionalism hinder content mastery and accurate competency assessment. Grading should focus on mastery of skill and content, using summative assessments for final grades, a no-zero policy, and actionable feedback. Equitable grading supports learners from all backgrounds and identities and promotes academic success. This case study provides guidance and recommendations for implementing equitable grading practices in academic physical therapist programs.

Methods: Over a 2-year period, a doctor of physical therapy program began implementing 5 strategies to create more equitable grading practices: (1) eliminating zero grades, (2) allowing late assignment submissions without penalty, (3) using low-stakes formative assessments throughout the semester, (4) weighing end-of-course assessments more heavily than initial ones, and (5) offering a no-stakes anatomy prep course before matriculation.

Results: Outcomes from implementing equitable grading practices varied. Some learners felt increased stress from fewer points opportunities, while others appreciated the reduced anxiety from low-stakes assessments. Some saw multiple attempts for peers as unfair. Faculty faced higher workloads due to detailed feedback and remediation but believed it benefited learners. Median final grades improved in some courses, remained stable in others, and slightly decreased in one. Overall, the changes had minimal impact on most learners' grades but significantly improved outcomes and retention for struggling learners.

Conclusion: This case report documents the implementation of equitable grading practices in a Doctor of Physical Therapy program, offering valuable insights and recommendations for other institutions aiming to adopt similar practices.

Impact: Inequity in assessment widens the gap between learners entering professional programs. Equitable assessment practices level the playing field, enabling learners from diverse backgrounds and identities to succeed. Increased diversity benefits everyone, especially patients, by reducing health disparities for historically marginalized groups.

The push for holistic admissions practices in physical therapy education has evoked concerns that learners who are culturally and linguistically diverse might be less qualified than the predominant demographic traditionally admitted into programs. The implications are that culturally and linguistically diverse learners struggle academically and experience challenges passing the National Physical Therapy Examination. However, as the academic preparedness of learners is discussed, rarely does the conversation include the capabilities of faculty to teach these learners. As cohorts continue to include learners from a greater variety of backgrounds and identities, the largely homogenous professorate, with more than 80% identifying as White, might need training in culturally responsive pedagogy to best serve learners from all backgrounds and identities. Educators often use a "one-size-fits-all" approach in which learners are expected to use the same resources and pace for assignments, readings, and assessments, regardless of their learning strengths or academic preparation. That approach fails to empower educators to design curricula and instruction to position all learners to excel in the classroom. This Perspective explores strategies to support all learners through three dimensions of culturally responsive pedagogy: institutional, personal, and instructional. To truly transform society, we must first transform physical therapy education. Culturally responsive pedagogy advances and supports all student achievement by recognizing, fostering, and using their strengths in the learning environment.

In 2002, the Institute of Medicine's recommendations emphasized diversifying the health care workforce to reduce racial and ethnic health disparities. Despite these efforts, the physical therapist profession remains predominantly White. The College of Saint Mary Doctor of Physical Therapy (DPT) program employs deliberate strategies through 2 committees, faculty search and admissions, to foster diversity in both faculty and student populations. The DPT Program Faculty Search Committee, in collaboration with the human resource department, devised a comprehensive 3-phase recruitment process aimed at attracting qualified candidates from diverse backgrounds. Through purposeful mission-driven and equity-focused strategies, this approach has yielded a faculty body characterized by diversity, with 80% of faculty members self-identifying as belonging to historically excluded groups. Similarly, the Admissions Committee has adopted proactive measures to ensure a diverse student body. By implementing a holistic admissions process recommended by the Association of American Medical Colleges, including evaluating prerequisite courses and eliminating the Graduate Record Examination requirement, the committee has facilitated more equitable access to the program. Virtual interviews and thorough candidate assessments are conducted to mitigate potential biases in the selection process. As a result, these efforts have allowed us to maintain diverse cohorts, with 20% to 30% of our student body identifying as members of historically excluded groups.

Impact: Developing and sustaining a physical therapist workforce that reflects the communities it serves necessitates purposeful, mission-driven, and equitable strategies. These strategies aim to broaden the diversity of both faculty and student populations. Through such initiatives, we aim to foster an inclusive environment that reflects our society's richness, enabling us to better understand society's complex needs and mitigate health disparities.

Objective: The purpose of this paper is to determine a claims-based definition of frontloaded home health physical therapy (HHPT) and examine the effect of frontloaded HHPT visits on all-cause 30-day hospital readmissions.

Methods: This study used a retrospective analysis of Medicare fee-for-service claims from older adults (≥65 years) in the National Health and Aging Trends Study (NHATS; 2011-2017) with ≥1 HHPT visit within 30 days of a hospitalization (n = 1344 hospitalizations; weighted n = 7,727,384). An exploratory analysis of home health claim distribution was conducted to determine definitions of frontloaded HHPT. Generalized linear models were then used to examine the relationship between hospital readmission and each definition of frontloading.

Results: Four definitions of frontloaded HHPT were identified: ≥2 HHPT visits in the first week after discharge; ≥3 visits in the first week; ≥4 visits in the first 2 weeks; and ≥ 5 visits in the first 2 weeks. The adjusted risk of readmission was lower for older adults receiving frontloaded HHPT in the first week: (risk ratio [RR] for ≥2 vs <2 visits = 0.57; 95% CI = 0.41-0.79; RR for ≥3 vs <3 visits = 0.39; 95% CI = 0.22-0.72). The reduction in risk of readmission was even greater for older adults receiving ≥4 versus <4 HHPT visits (RR = 0.32; 95% CI = 0.21-0.48) and ≥ 5 versus <5 HHPT visits (RR = 0.27; 95% CI = 0.14-0.50) within the first 2 weeks. The effect of HHPT frontloading was greater for patients hospitalized with surgical versus medical diagnoses and for patients with diagnoses targeted by the Hospital Readmissions Reduction Program.

Conclusion: Frontloaded HHPT reduces 30-day hospital readmissions among Medicare beneficiaries. Additional research is needed to determine the optimal number of visits and those most likely to benefit from frontloaded HHPT.

Impact: Frontloaded HHPT can be an effective approach for reducing 30-day hospital readmissions among Medicare beneficiaries.

Objective: The aims of the current study were to investigate the presence of widespread pressure hyperalgesia, the presence of structural changes in the wrist extensor tendon and muscle, and their association in people with lateral epicondylalgia (LE).

Methods: Thirty-seven patients with LE (43% women; mean age = 45.5 [SD = 9.5] years) and 37 controls matched for age and sex and free of pain participated in this study. Pressure pain thresholds (PPTs) were assessed bilaterally over the symptomatic area (elbow), 2 segment-related areas (C5-C6 joint, second intermetacarpal space), and 1 remote area (tibialis anterior) in a blinded design. Ultrasound measurements (eg, cross-sectional area, thickness, and width) of the common wrist extensor tendon and extensor carpi radialis brevis muscle as well as the thickness of the supinator muscle were assessed.

Results: Patients with LE exhibited lower PPTs bilaterally at all points and lower PPTs at the lateral epicondyle and second intermetacarpal space on the symptomatic side as compared to the nonsymptomatic side (η2 from 0.123-0.369; large effects). Patients exhibited higher cross-sectional area and width of the common wrist extensor tendon (η2 from 0.268-0.311; large effects) than controls bilaterally, whereas tendon thickness was also higher (η2 = 0.039; small effects) on the painful side than on the nonpainful side.

Conclusions: This study reported bilateral widespread pressure pain hyperalgesia and morphological changes in the tendon, but not the muscle, in LE. Pressure pain sensitivity and morphological changes were not associated in individuals with LE.

Impact: Management of LE should consider altered nociceptive pain processing and structural tendon changes as 2 different phenomena in patients with LE.

Objective: This paper describes how the administrative leadership of 1 physical therapy department curated, implemented, and evaluated a culturally responsive administrative support strategy to foster a positive working environment. Participants' perceptions of culturally responsive practices were explored using climate survey data.

Methods: This case occurred in the physical therapy and rehabilitation science department at an academic medical center in the United States. The department administers 5 educational programs, 3 faculty practices, a community clinic, and a robust research enterprise and employs over 100 employees. After a historic sociocultural event, administrators implemented a series of actions to understand the needs of department employees and to respond in a culturally responsive manner. Interventions included supportive activities, educational opportunities, and community-building events. The department administered an annual climate survey to assess the employees' perceptions of the working climate, perceived impacts of the culturally responsive interventions, and suggestions for improving department climate. Survey analysis included frequency statistics and thematic content analysis with sensitizing concepts from a culturally responsive practice framework previously applied in primary and secondary school settings.

Results: A total of 131 employees participated in the annual climate survey from 2020 to 2022. Employees' confidence to identify and address microaggressions in working environments showed trends of overall improvement, and overall self-reported experiences with racial discrimination decreased. Participants reported positive trends in addressing discrimination among colleagues but also reported addressing offensive behaviors perpetrated by patients.

Conclusion: Findings suggest that culturally responsive interventions are associated with positive trends in employee climate. Interventions tailored to the audience and curated to deepen cultural knowledge, enhance self-awareness, and validate others fostered a shared commitment to cultural equity.

Impact: Administrative leaders have a role in fostering an inclusive climate by capitalizing on culturally significant teachable moments with sound culturally responsive strategy, bidirectional culturally sensitive communication, individual development, and collective action.

People with disabilities are considered a historically marginalized population that experiences significant health disparities resulting from the unequal distribution of resources as evidenced in the social determinants of health. Health professions education presents an opportunity to explore the policy, systems, and environmental changes that are needed to improve social conditions and address known disparities for people with disabilities. Evidence suggests that inclusion of learners with diverse lived experiences, including students with disabilities, strengthens our understanding of the influence of social determinants on health and our ability to address known barriers. Unfortunately, people with disabilities and other minoritized individuals are grossly underrepresented in physical therapy. It is imperative that doctor of physical therapy (DPT) education more intentionally promotes the full inclusion of students with disabilities to improve representation and to better support the complex needs of this population. In this perspective, we describe key social determinants of health for people with disabilities, offer strategies for increasing representation and inclusion of students with disabilities in DPT education, and summarize how the inclusion of students with disabilities in DPT education can enhance our understanding of and ability to address social barriers for this population.

The purpose of this perspective is to discuss the imperative for curricular change that focuses on the utilization of structural competency to promote excellence in physical therapist professional education, transform society, and achieve health equity. Pedagogy centered around biomedical and social determinants of health (SDOH) models are limited in that they lack self-reflexivity, encode social identities like race and gender as risk factors for poor health, fail to examine structural causes of health inequity, conflate SDOH and the structural forces that shape their unequal distribution, and overlook instances of injustice. Promoting health equity will require structural competency, an approach that considers drivers of health beyond the individual and their conditions of daily living (ie, SDOH). Utilizing this approach in physical therapist professional education will help learners understand the evolving needs of society in a deeper, more holistic way: one that considers structural determinants of health as the primary drivers of health equity and inequity.

Impact: This paper provides a perspective on how physical therapist professional education can promote health equity for all by embracing an equity-focused, structurally competent pedagogy/approach.