Physical Therapy

Cho, Han Eol; Choi, Won Ah; Lee, Sang-Yoep; Kang, Seong-Woong

doi: 10.1093/ptj/pzac092pmid: 35913796

ObjectiveAlthough air stacking is a widely used lung expansion therapy essential for restrictive lung diseases, important details such as peak insufflation pressure (PIP) and number of squeezes have not been investigated. The purpose of this study was to standardize a method of air stacking to minimize problems with its application by identifying the optimal pressure and number of squeezes performed by professional physicians and investigating the current status of routine air stacking implementation in patients.MethodsThis prospective cross-sectional test–retest study involved individuals who had neuromuscular disorders and had performed air stacking exercise for longer than 1 year. PIP and number of squeezes were measured to identify the differences between caregivers and physicians. Cases of incorrectly performed air stacking were investigated and categorized. The problems associated with air stacking were evaluated.ResultsA total of 45 participants were included. PIP was 41.4 (SD = 4.2; range = 34.8–50.0) cm H2O, and optimal number of squeezes was 3.1 (SD = 0.5; range = 2–4). When the air stacking methods used by caregivers were evaluated, 19 of 45 caregivers (42.2%) used methods inappropriately. Higher PIP and larger number of squeezes were observed with caregiver implementation. Thirty caregivers (66.7%) experienced finger or wrist pain; this problem was observed especially in female caregivers, who tended to incorrectly perform air stacking.ConclusionsThis pilot study showed that the optimal pressure of air stacking was 35 to 50 cm H2O. Caregivers often perform air stacking inappropriately, leading to complications without achieving the purpose of air stacking. The introduction of a new method, such as manometry, can be helpful for achieving optimal air stacking.ImpactOptimal pressure of air stacking can be measured with inexpensive, simple, and commercially available digital manometry. This approach enables air stacking to be performed and taught more accurately and efficiently and reduces complications in both patients and caregivers.

Furze, Jennifer A; Black, Lisa; McDevitt, Amy W; Kobal, Kara L; Durning, Steven J; Jensen, Gail M

doi: 10.1093/ptj/pzac093pmid: 35781736

Education: Postprofessional, Education: Competency-Based, Clinical Reasoning Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. Article PDF first page preview Close This content is only available as a PDF. © The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: [email protected]

Davenport, Todd E; Griech, Sean F; Deamer, Kathryn E; Gale, Lewis R

doi: 10.1093/ptj/pzac087pmid: 35778932

Physical therapists are uniquely positioned through their knowledge and skills to help people become more physically active, which may reduce the consequences of physical inactivity for health-related quality of life and the global economy. The “Exercise Is Medicine” campaign was introduced in 2007. It holds that exercise may be prescribed like a medicine. Although this analogy doubtlessly has promoted innumerable life-changing conversations between clinicians and patients, there are important shortcomings to considering physical activity and exercise as medicine. In the United States, many of these shortcomings relate to how medical services are provided and remunerated. Medical care is provided in the context of exclusive groups, which are established by insurance, preferred service populations, or other characteristics that determine a basis for providing care. Exclusivity means that medical care is frequently provided in a type of club. The club structure of medical care jeopardizes the ability of nonmembers to benefit. Medical care clubs based on payment create an environment in which nonpaying customers may not benefit in the same manner as paying customers from approaches that consider exercise prescribed as medicine. This clinical perspective reviews the characteristics of exercise as a good, focusing on how it is prescribed by physical therapists. It discusses how physical therapists may become involved in the process of making exercise a public good by reducing its exclusivity. Multiple levels of involvement are recommended at the societal, community, and individual levels. These involvements may be guided by an existing construct proposed by the World Health Organization, which would bring the global physical therapy profession into a common alignment. This Perspective concludes with a discussion that anticipates the shortcomings of conceptualizing exercise as a public good to be addressed in future service delivery models.

Manhas, Kiran Pohar; O’Connell, Petra; Krysa, Jacqueline; Henderson, Isabel; Ho, Chester; Papathanassoglou, Elisavet

doi: 10.1093/ptj/pzac090pmid: 35778936

ObjectiveThe purpose of this study was to describe the development and composition of a codesigned, multidisciplinary, integrated, systematic rehabilitation framework for post-COVID conditions (PCC) that spans the care continuum to streamline and standardize rehabilitation services to support persons with PCC in Alberta, Canada.MethodsA collaborative, consensus-based approach was used involving 2 iterative provincial taskforces in a Canadian provincial health system. The first taskforce (59 multidisciplinary stakeholders) sought to clarify the requisite facets of a sustainable, provincially coordinated rehabilitation approach for post-COVID rehabilitation needs based on available research evidence. The second taskforce (129 multidisciplinary stakeholders) translated that strategy and criteria into an operational framework for provincial implementation. Both taskforces sought to align with operational realities of the provincial health system.ResultsThe summation of this collaborative consensus approach resulted in the Provincial Post COVID-19 Rehabilitation Response Framework (PCRF). The PCRF includes 3 care pathways across the care continuum specifically targeting in-hospital care, continuing care, and community-based care with 3 key elements: (1) the use of specific symptom screening and assessment tools to systematically identify PCC symptoms and functional impairments, (2) pathways to determine patients’ rehabilitation trajectory and guide their transition between care settings, and (3) self-management and education resources for patients and providers.ConclusionThe PCRF aligns with international mandates for novel, codesigned, multidisciplinary approaches to systematically address PCC and its myriad manifestations across the care continuum. The PCRF allows for local adaptation and highlights equity considerations, allowing for further spread and scale provincially, nationally, and internationally.ImpactThe PCRF is a framework for health systems to ensure consistent identification, assessment, and management of the rehabilitation needs of postacute and chronic PCC. Rehabilitation providers and health systems can build from the PCRF for their local communities to reduce unmet needs and advance the standardization of access to rehabilitation services for persons with PCC.

Clark, Diane; Wainwright, Susan; Tschoepe, Barbara A; Green-Wilson, Jennifer; Sebelski, Chris; Zeigler, Stacey; McGinnis, Patricia

doi: 10.1093/ptj/pzac089pmid: 35871414

Professionalism has been the foundation of physical therapy’s contract with society, with the American Physical Therapy Association’s (APTA) Core Values and Code of Ethics serving as its building blocks. Professional formation has focused on professionalism and has been taught in a manner that is more implicit than explicit in doctor of physical therapy (DPT) curricula. As a domain of competence, professionalism alone has not been broad enough to meet societal needs. In reaching our centennial year, many have reflected on what competencies are needed to move forward. The need for leadership competencies is not new and has been espoused by our leaders over the past 100 years. Some advocate for the adoption of leadership as a unique domain of competence, separate from the domain of professionalism, whereas others propose that either professionalism or leadership is one domain of competence that subsumes the other. The purpose of this Perspective is twofold: to compare and contrast the concepts of professionalism and leadership, and to make recommendations regarding what constitutes domains of competence within the professional formation of physical therapists. This Perspective offers recommendations addressing professional formation and the adoption of leadership and professionalism as 2 distinct domains of competence and discusses educational and clinical implications of the recommendations. This Perspective asserts that these recommendations must be adopted to move the profession forward into the next century so that physical therapists are recognized as adding value to the health care system and the evolving needs of society.

Fisher, Mary Insana; Cohn, Joy C; Harrington, Shana E; Lee, Jeanette Q; Malone, Daniel

doi: 10.1093/ptj/pzac120pmid: 36179114

 Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. Regular surveillance is recommended, but few clinical practice guidelines transparently assess study bias, quality, and clinical utility in deriving recommendations of screening and assessment methods. The purpose of this clinical practice guideline (CPG) is to provide recommendations for the screening and assessment of CRF for health care professions treating individuals with cancer. Following best practices for development of a CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) Statement and Emergency Care Research Institute (ECRI) Guidelines Trust Scorecard, this CPG included a systematic search of the literature, quality assessment of included evidence, and stakeholder input from diverse health care fields to derive the final CPG. Ten screening and 15 assessment tools supported by 114 articles were reviewed. One screen (European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire–30 Core Questionnaire) and 3 assessments (Piper Fatigue Scale–Revised, Functional Assessment of Chronic Illness Therapy–Fatigue, and Patient Reported Outcome Measurement Information System [PROMIS] Fatigue-SF) received an A recommendation (“should be used in clinical practice”), and 1 screen and 5 assessments received a B recommendation (“may be used in clinical practice”). Health care providers have choice in determining appropriate screening and assessment tools to be used across the survivorship care continuum. The large number of tools available to screen for or assess CRF may result in a lack of comprehensive research evidence, leaving gaps in the body of evidence for measurement tools. More research into the responsiveness of these tools is needed in order to adopt their use as outcome measures.ImpactHealth care providers should screen for and assess CRF using one of the tools recommended by this CPG.

Kigin, Colleen M

doi: 10.1093/ptj/pzac100pmid: 36173758

Colleen M. Kigin, PT, DPT, MS, MPA, FAPTA, the 52nd Mary McMillan Lecturer, is a consultant focused on innovation. She is a visiting clinical professor at the University of Colorado physical therapy program, University of Colorado School of Medicine, and an adjunct associate professor at the MGH Institute of Health Professions (MGH IHP). From 1998–2014, she held the positions of chief of staff and program manager for the Center of Integration of Medicine and Innovative Technology, a 12-institution consortium based in Boston, Massachusetts, developing innovative solutions to health care problems. She subsequently has served as a consultant to such efforts as the University of Manchester, Manchester Academic Health Science Centre, United Kingdom, to develop an innovation culture. In 1994, she joined the newly formed Partners HealthCare System in Boston, coordinating the system's cost reduction efforts through 1998. Kigin previously served as director of physical therapy services at Massachusetts General Hospital (MGH) (1977–1984) and as assistant professor at MGH IHP (1980–1994). While at MGH, she was responsible for the merger of 2 separate physical therapy departments, the establishment of the first nonphysician specialist position, and practice without referral for the physical therapy services. Kigin has held numerous positions within the American Physical Therapy Association (APTA), serving on the Board of Directors from 1988–1997, including as vice president; co-chair of The Physical Therapy Summit in 2007; and co-chair of FiRST, the Frontiers in Rehabilitation, Science and Technology Council. She also served as prior chair of the APTA Committee on Clinical Residencies and served on the American Board of Physical Therapy Specialties. Kigin earned a bachelor of science degree in physical therapy at the University of Colorado, a master of science degree at Boston University, a master's degree in public administration from the Harvard Kennedy School of Government, and a doctor in physical therapy degree from the MGH IHP.

Beattie, Paul; Jernigan, Darin; McDavitt, Stephen; Hearn, Darren

doi: 10.1093/ptj/pzac096pmid: 35871444

Wilderness Injury, Tactical Athlete, Search and Rescue, Emergency Care, Direct Access Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. Article PDF first page preview Close This content is only available as a PDF. © The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: [email protected]

Herrmann, Tessa; Iglesias, Jacqueline; Smith, Samantha

doi: 10.1093/ptj/pzac070pmid: 35648112

ObjectiveIn the setting of the COVID-19 pandemic, lung transplantation is being used as a life-saving treatment. This case report describes the rehabilitation course of the first documented individual in the United States post bilateral lung transplant for COVID-19.Methods (Case Description)The patient is a 28-year-old woman who was previously healthy and who failed all other life-saving medical interventions before undergoing bilateral lung transplantation, resulting in an extended hospital stay and significant physical debility.ResultsThrough an interdisciplinary rehabilitation approach, the patient was able to achieve functional improvements in strength, balance, endurance, and functional mobility to safely discharge home.ConclusionResearch is needed regarding optimal treatment of this patient population because lung transplantation continues to be used for long-term medical management of COVID-19 infection.ImpactThis is a case report describing rehabilitation for the first documented individual in the United States post bilateral lung transplant for COVID-19.

Chapman, Chelsea R; Woo, Nathan T; Maluf, Katrina S

doi: 10.1093/ptj/pzac081pmid: 35778939

ObjectiveLack of clarity regarding effective communication behaviors in chronic pain management is a barrier for implementing psychologically informed physical therapy approaches that rely on competent communication by physical therapist providers. This study aimed to conduct a systematic review and meta-synthesis to inform the development of a conceptual framework for preferred communication behaviors in pain rehabilitation.MethodsTen databases in the health and communication sciences were systematically searched for qualitative and mixed-method studies of interpersonal communication between physical therapists and adults with chronic pain. Two independent investigators extracted quotations with implicit and explicit references to communication and study characteristics following Standards for Reporting Qualitative Research and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality for individual studies was assessed with Critical Appraisal Skills Programme, and quality of evidence was evaluated with GRADE-CERQual. An inductive thematic synthesis was conducted by coding each quotation, developing descriptive themes, and then generating behaviorally distinct analytical themes.ResultsEleven studies involving 346 participants were included. The specificity of operationalizing communication terms varied widely. Meta-synthesis identified 8 communication themes: (1) disclosure-facilitating, (2) rapport-building, (3) empathic, (4) collaborative, (5) professional accountability, (6) informative, (7) agenda-setting, and (8) meta-communication. Based on the quality of available evidence, confidence was moderate for 4 themes and low for 4 themes.ConclusionThis study revealed limited operationalization of communication behaviors preferred by physical therapists in chronic pain rehabilitation. A conceptual framework based on 8 communication themes identified from the literature is proposed as a preliminary paradigm to guide future research.ImpactThis proposed evidence-based conceptual framework for preferred communication behaviors in pain rehabilitation provides a framework for clinicians to reflect on their own communication practices and will allow researchers to identify if and how specific communication behaviors impact clinical outcomes.