Physical Therapy最新文献

{"title":"\"It's Just Really Important for Us All to Be on the Same Page\": Qualitative Evaluation of Factors That Influence Written Mobility Communication.","authors":"Sally Yin, Prue McRae, Julie Adsett, Alison Mudge","doi":"10.1093/ptj/pzae158","DOIUrl":"10.1093/ptj/pzae158","url":null,"abstract":"<p><strong>Objective: </strong>Poor interdisciplinary team communication is a known barrier to increasing inpatient mobility. Understanding why and how clinicians from different disciplines communicate about mobility would help inform communication improvements. This qualitative interview study aimed to describe and explore clinician perceptions about written mobility communication and perceived barriers and enablers to this communication.</p><p><strong>Methods: </strong>A rapid deductive qualitative approach was used to efficiently capture information for local improvement. Clinicians (physical therapists, nurses, physicians, and occupational therapists) working on 3 internal medicine wards in a metropolitan teaching hospital in Brisbane, Australia were purposefully sampled and invited to participate in individual interviews. Questions were based on the Consolidated Framework for Implementation Research. Interviews were recorded, transcribed, and analyzed using deductive and inductive thematic methods.</p><p><strong>Results: </strong>From 17 interviews, key themes identified that written communication about patient mobility is important and valued by clinicians; clinicians learn documentation on the job, often from physical therapists; clinicians are not aware of organizational responsibility for mobility communication; multiple purposes for written communication contribute to multiple locations and inconsistency; and clinicians perceive that improvement would require a multidisciplinary and multilevel approach. Suggestions for improvement included the use of a common language, consistent use of existing bedside communication tools, and clearer responsibility for written communication about mobility.</p><p><strong>Conclusion: </strong>Written communication about patient mobility was valued by clinicians, and a range of barriers to effective interdisciplinary communication was identified. Clear professional roles and responsibility for written mobility communication are important. Suggestions for improvement included an interdisciplinary language supported by multidisciplinary education and organizational governance.</p><p><strong>Impact: </strong>Written communication about patient mobility is recognized as critical to safe, high-quality hospital care. Our findings suggest that successful mobility communication improvements must involve multiple disciplines and include clear organizational governance to support staff training, clear role responsibilities, and quality monitoring.</p><p><strong>Lay summary: </strong>This study found that staff on a medical ward think writing about mobility is important for patient and staff safety. Having clear roles and responsibilities for writing about mobility is important and consistency may be improved through education and training.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591307","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":"Determinants of Longitudinal Changes in Exercise Capacity in Patients With Independent Functioning on Hemodialysis.","authors":"Naoto Usui, Junichiro Nakata, Akimi Uehata, Sho Kojima, Hideki Hisadome, Akihito Inatsu, Atsuhiro Tsubaki, Masakazu Saitoh, Shuji Ando, Tatsuro Kitayama, Kenta Maikusa, Yuki Nishiyama, Yusuke Suzuki","doi":"10.1093/ptj/pzae147","DOIUrl":"10.1093/ptj/pzae147","url":null,"abstract":"<p><strong>Objective: </strong>Patients with chronic kidney disease reportedly have decreased muscle oxygen utilization, which most substantially decreases exercise capacity, followed by cardiac reserve. However, determinants of longitudinal changes in exercise capacity in patients on hemodialysis (HD) and the effects of long-term exercise interventions (EI) are unknown. This study was conducted to clarify these concerns.</p><p><strong>Methods: </strong>This was a prospective cohort study. Patients on HD that were not hospitalized were followed from baseline up to 2 years, and cardiopulmonary exercise testing results, including peak oxygen uptake, peak work rate, heart rate reserve, and ventilatory equivalent for carbon dioxide slope, as well as implementation of EI were assessed. Based on the 2-year change in peak oxygen uptake, they were divided into improvement or declined groups.</p><p><strong>Results: </strong>Forty-five patients who were not hospitalized completed the follow-up were analyzed. In the improvement group, the variation was determined by an increase in peak work rate, which is a peripheral factor (partial regression coefficient 0.08 [95% CI = 0.01 to 0.16]), while in the decline group, the variation was determined by a decrease in the ventilatory equivalent for carbon dioxide slope, which is a cardiac factor (partial regression coefficient = -0.12; 95% CI = -0.21 to -0.03). Moreover, exercise intervention was associated with the change in peak oxygen uptake (partial regression coefficient = 3.09; 95% CI = 1.45 to 4.72).</p><p><strong>Conclusion: </strong>Exercise intolerance even in patients on HD that were not hospitalized and stable progressed over time with deterioration of cardiac reserve, whereas EI were associated with improved exercise capacity through enhanced peripheral function.</p><p><strong>Impact: </strong>The results support the early measurement of cardiopulmonary or skeletal muscle reserve through cardiopulmonary exercise testing and the implementation of long-term EI based on the measurement results to address the potential deterioration in exercise capacity associated with reduced cardiac reserve, even in patients on HD that are asymptomatic and stable.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472318","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":"The Effects of Ankle and Foot Exercises on Ankle Strength, Balance, and Falls in Older People: A Systematic Review and Meta-Analysis.","authors":"Sam Guoshi Liang, Joman Chung Man Chow, Nga Ming Leung, Yee Nok Mo, Thomas Ming Hin Ng, Christy Lok Ching Woo, Freddy Man Hin Lam","doi":"10.1093/ptj/pzae157","DOIUrl":"10.1093/ptj/pzae157","url":null,"abstract":"<p><strong>Objective: </strong>Ankle-foot control is essential to maintain balance and gait stability. However, there has been limited evidence on the effect of ankle-foot exercises on balance and falls in older people. This study aimed to summarize the effects of ankle-foot exercises on ankle flexibility and strength, balance, mobility, and falls in older people and to identify determining factors for ankle-foot exercises to improve balance and mobility.</p><p><strong>Methods: </strong>Cumulative Index to Nursing and Allied Health Literature, Embase, PubMed, and Physiotherapy Evidence Database (PEDro) were searched to identify randomized controlled trials that studied the effects of ankle-foot exercises on ankle control, balance, and falls in older people. The PEDro scale was used to evaluate the methodological quality of the studies. Meta-analyses were done for similar outcomes. The quality of evidence was rated by GRADE.</p><p><strong>Results: </strong>Sixteen papers (n = 651) were included. Meta-analyses showed that ankle-foot exercises significantly improved ankle plantarflexion strength (SMD = 0.35, 95% CI = 0.04 to 0.65, low-quality evidence), ankle flexibility (SMD = 0.48, 95% CI = -0.01 to 0.96, low-quality evidence), and balance in an eyes-open condition (SMD = 0.41, 95% CI = 0.19 to 0.70, low-quality evidence). There was no significant change in ankle dorsiflexion strength (SMD = 0.29, 95% CI = -0.24 to 0.82, very low-quality evidence), balance under eyes-closed condition (SMD = 0.41, 95% CI = -0.1 to 0.92, very low-quality evidence), and gait speed (SMD = 0.36, 95% CI = -0.24 to 0.96, very low-quality evidence). Two studies reported insignificant findings on fear of falling, fall incidence, and risk of falls.</p><p><strong>Conclusions: </strong>Very low- to low-quality evidence showed that ankle-foot exercises effectively improve ankle plantarflexion strength, flexibility, and balance with eyes open, whereas no effect on falls was found. Improvements in balance and gait tend to be associated with improvements in ankle strength and flexibility. Toe-strengthening exercise and training 3 times per week appear to be important for improving balance.</p><p><strong>Impact: </strong>This review suggested that ankle-foot exercises might improve balance in older people. Determining factors leading to improvement in balance and mobility were identified. It paves the ground for further research to study the effect of ankle-foot exercises on fall prevention.</p><p><strong>Lay summary: </strong>Ankle and foot exercises appear to be effective in improving ankle plantarflexion strength, flexibility, and balance performance in an eye-open condition. If you are an older adult who wants to improve your balance, your physical therapist may prescribe ankle and foot exercises as a supplemental component in a fall prevention program due to the observed improvements in balance and the safety and ease of the exercise.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829701","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":"Functional Recovery of Adults Following Acute COVID-19: A Systematic Review and Meta-Analysis.","authors":"Sophie Middleton, Christos V Chalitsios, Tanvi Mungale, Zeinab M Hassanein, Alex R Jenkins, Charlotte E Bolton, Tricia M McKeever","doi":"10.1093/ptj/pzae023","DOIUrl":"10.1093/ptj/pzae023","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aimed to investigate the objective, functional recovery of patients more than 3 months after acute coronavirus disease 2019 (COVID-19) infection.</p><p><strong>Methods: </strong>Comprehensive database searches of EMBASE, PubMed/MEDLINE, Cochrane COVID-19 Study Register, CINAHL, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were carried out until October 19, 2022. Data were extracted and agreed in duplicate. Data were narratively synthesized, and a series of meta-analyses were performed using the random-effects inverse variance method.</p><p><strong>Results: </strong>One-hundred six papers covering 20,063 patients, who were either hospitalized or not hospitalized with acute COVID-19 and were followed-up between 3 and 24 months, were included. Percentage predicted 6-minute walk distance at 3 months to <5 months was 84.3% (95% CI = 79.2-89.3; n = 21; I2 = 98.3%) and 92.5% (95% CI = 89.8-95.3; n = 9; I2 = 94.5%) at ≥11 months. Cardiopulmonary exercise testing revealed the percentage predicted peak oxygen consumption rate ($peakdot{mathsf{V}}{mathsf{o}}_{mathsf{2}}$) at 3 months to <5 months was 77.3% (95% CI = 71.0-83.7; n = 6; I2 = 92.3%) and 95.4% (95% CI = 87.1-103.6; n = 2; I2 = 77.3%) at ≥11 months. Mean handgrip strength was greatest at ≥11 months at 31.16 kg (95% CI = 19.89-42.43; n = 2; I2 = 98.3%) of all time points. All analyses showed marked heterogeneity.</p><p><strong>Conclusion: </strong>Patients have reduced physical function more than 3 months after COVID-19 infection. Better physical function in multiple physical domains is found after a longer recovery time.</p><p><strong>Impact: </strong>Physical function as measured by the 6-minute walk test, hand grip strength, and cardiopulmonary exercise testing is reduced at 3 months after COVID-19 infection and can remain over 11 months of follow-up. This protracted recovery following acute COVID-19 infection supports the need to assess physical function at any clinical follow-up, and further research into rehabilitation programs and intervention for patients who have not recovered.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11738174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139932407","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}

{"title":"Theory-Informed Development of a Multicomponent Intervention to Implement Clinical Practice Guideline Recommendations in the Management of Shoulder Pain.","authors":"Véronique Lowry, François Desmeules, Patrick Lavigne, Simon Décary, Yannick Tousignant-Laflamme, Marylie Martel, Jean-Sébastien Roy, Kadija Perreault, Marie-Claude Lefebvre, Kelley Kilpatrick, Anne Hudon, Diana Zidarov","doi":"10.1093/ptj/pzae160","DOIUrl":"10.1093/ptj/pzae160","url":null,"abstract":"<p><strong>Objective: </strong>Suboptimal primary health care management of shoulder pain has been reported in previous studies. Implementing clinical practice guidelines (CPGs) recommendations using a theoretical approach is recommended to improve shoulder pain management. This study aims to identify determinants of implementing recommendations from shoulder CPGs to help develop an intervention based on the identified determinants.</p><p><strong>Methods: </strong>Family physicians and physical therapists managing patients with shoulder pain in primary care were invited to participate in a qualitative study to identify determinants to implementing recommendations from shoulder CPGs. The Theoretical Domains Framework (TDF) was used to inform the creation of the semi-structured interview guide and for deductive coding of transcriptions. The determinants were mapped to intervention functions and behavior change techniques (BCT) using the Behavior Change Wheel method and strategies for implementing CPGs recommendations were identified.</p><p><strong>Results: </strong>Interviews were conducted with 16 family physicians and 19 physical therapists. We identified 12 barriers and 6 facilitators within 7 TDF domains: knowledge, skills, beliefs about capabilities, beliefs about consequences, intentions, environmental context and resources, and social influence. We identified 6 intervention functions and 12 BCT addressing the relevant determinants. The 11 implementation strategies identified include the development and distribution of educational material, interactive educational outreach visits, and audit and feedback. Other components to consider are the identification and preparation of champions in primary care clinical settings, revision of professional roles, and creation of interdisciplinary clinical teams.</p><p><strong>Conclusions: </strong>The identification of barriers and facilitators to implementing recommendations from shoulder CPGs allowed us to select implementation strategies at individual and organizational levels.</p><p><strong>Impact: </strong>The implementation strategies will be adapted to specific primary care contexts in consultation with stakeholders and operationalized into a multicomponent implementation intervention. Implementing the intervention has the potential to improve shoulder pain management in primary care and facilitate the use of evidence-based recommendations from CPGs.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818956","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":"Author Response to Kumar et al.","authors":"Leonardo Avila, Morgana Duarte da Silva, Marcos Lisboa Neves, Andre Rogerio Abreu, Cibelle Ramos Fiuza, Leandro Fukusawa, Arthur de Sá Ferreira, Ney Meziat-Filho","doi":"10.1093/ptj/pzae162","DOIUrl":"10.1093/ptj/pzae162","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626222","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":"Short-Term Powered Mobility Intervention Is Associated With Improvements in Development and Participation for Young Children With Cerebral Palsy: A Randomized Clinical Trial.","authors":"Heather A Feldner, Samuel W Logan, Sango Otieno, Anna Fragomeni, Carissa Kono, Katie Riordan, Bethany Sloane, Lisa K Kenyon","doi":"10.1093/ptj/pzae152","DOIUrl":"10.1093/ptj/pzae152","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the effects of 2 short-term powered mobility interventions across developmental domains, participation, and perceptions of intervention implementation for young children with cerebral palsy and their families.</p><p><strong>Methods: </strong>This randomized, crossover clinical trial compared 2 powered mobility interventions: the Explorer Mini (Permobil AB, Timra, Sweden) and an adapted ride-on toy car. Analyses included 24 children aged 12 to 36 months, recruited from 3 sites. Each device was trialed in the home for an 8-week period for a total of 16 weeks. Three in-person study visits took place at baseline, crossover, and study completion, and 2 additional virtual check-ins were conducted for each device trial period. Outcome measures included all domains of the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4); Child Engagement in Daily Life (CEDL) participation questionnaire; and t3 perceptual implementation measures: Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure. Analyses included descriptive statistics, 2 by 3 group × time analysis of variance, and post hoc t tests as warranted.</p><p><strong>Results: </strong>Statistically significant mean improvements were observed in all domains of the Bayley-4 and in the self-care subscale of the CEDL regardless of device order. Caregivers ranked both devices as acceptable and feasible to implement, although the Explorer Mini was ranked slightly more favorably than the adapted ride-on toy car, with a device order effect being observed.</p><p><strong>Conclusion: </strong>Short-term powered mobility intervention may advance multiple domains of development and participation for young children with cerebral palsy. Caregivers rated 2 different powered mobility devices favorably as part of their child's early intervention strategies.</p><p><strong>Impact: </strong>This study enhances the quality of evidence available to clinicians and families to support decision-making about powered mobility intervention for young children with motor disabilities, especially those who may be reluctant to begin powered mobility due to stigma or concern for motor skill development.</p><p><strong>Lay summary: </strong>In this study, children with cerebral palsy used 2 different powered mobility devices over 16 weeks. The goal of the study was to understand how powered mobility device use affected the children's movement, communication, learning, and social interactions. The goal was also to understand how caregivers felt about the intervention and device options.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505893","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":"Effects of Educational Interventions Designed to Develop Physical Therapist Learners' Clinical Reasoning: A Systematic Review.","authors":"Wing Fu, Tobi F Baldwin, Jacklyn H Brechter, Mark R Erickson, Kara Kobal, Vicki LaFay, Teresa M Miller, Jaclyn Morales","doi":"10.1093/ptj/pzae182","DOIUrl":"https://doi.org/10.1093/ptj/pzae182","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this systematic review was to investigate the effects of educational interventions designed to develop physical therapist learners' clinical reasoning across the full continuum of professional development.</p><p><strong>Data sources: </strong>A systematic search was conducted of 6 databases, the entire Journal of Physical Therapy Education collection, and the reference lists of included articles through March 2022.</p><p><strong>Study selection: </strong>English-language primary relevant research studies of all research designs were included while grey literature was excluded.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently extracted data from and determined risk of bias of each of the 40 included studies. Disagreements were resolved by consensus or use of a third reviewer. A narrative synthesis summarized and explained the quantitative data. Meta-analysis was not possible due to data heterogeneity. Qualitative data were synthesized using thematic analysis.</p><p><strong>Main outcome(s) and measure(s): </strong>Main outcomes were effects of the educational interventions per the Kirkpatrick model.</p><p><strong>Results: </strong>Forty articles met the inclusion criteria. Twenty-two of the 33 studies with quantitative data involving student or practicing physical therapists reported statistically significant positive outcomes. Three major themes emerged from thematic analysis of 23 studies: perceived educational gain, valued elements of educational interventions, and identified challenges to learning.</p><p><strong>Conclusions and relevance: </strong>Educational interventions that appeared to have a positive impact on learning outcomes were identified. However, the available research lacks rigor for the authors to develop evidence-based guidelines to support the development of clinical reasoning in physical therapist learners. Given the importance of clinical reasoning, high quality studies are warranted. This comprehensive systematic review appeared to be the first one in the profession to have investigated the effects of educational interventions designed to develop learners' clinical reasoning across the entire professional development. Educators and researchers may benefit from the findings to develop educational interventions and future studies.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882521","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":"Frailty Is Strongest Need Factor among Predictors of Prehabilitation Utilization for Total Hip or Knee Arthroplasty in Fee-for-Service Medicare Beneficiaries.","authors":"Brocha Z Stern, Graham C Sabo, Uma Balachandran, Raquelle Agranoff, Brett L Hayden, Calin S Moucha, Jashvant Poeran","doi":"10.1093/ptj/pzae183","DOIUrl":"https://doi.org/10.1093/ptj/pzae183","url":null,"abstract":"<p><strong>Objective: </strong>Prehabilitation may have benefits for total hip arthroplasty (THA) and total knee arthroplasty (TKA), given an aging population with multimorbidity and the growth of value-based programs that focus on reducing postoperative costs. We aimed to describe prehabilitation use and examine predictors of utilization in fee-for-service Medicare beneficiaries.</p><p><strong>Methods: </strong>This retrospective cohort study using the Medicare Limited Data Set included fee-for-service Medicare beneficiaries who were ≥ 66 years old and who underwent inpatient elective THA or TKA between January 1, 2016, and September 30, 2021. We assessed predictors of receiving preoperative physical therapist services within 90 days of surgery (prehabilitation) using a mixed-effects generalized linear model with a binary distribution and logit link. We report adjusted odds ratios (ORs).</p><p><strong>Results: </strong>Of 24,602 THA episodes, 18.5% of patients received prehabilitation; of 38,751 TKA episodes, 17.8% of patients received prehabilitation. For both THA and TKA, patients with medium or high (vs low) frailty were more likely to receive prehabilitation (OR = 1.72-2.64). Male (vs female) patients, Black (vs White) patients, those with worse county-level social deprivation, those with dual eligibility, and those living in rural areas were less likely to receive prehabilitation before THA or TKA (OR = 0.65-0.88). Patients who were ≥ 85 years old (vs 66-69 years old) and who underwent THA were also less likely to receive services (OR = 0.84). Additionally, there were geographic differences in prehabilitation utilization and increased utilization in more recent years.</p><p><strong>Conclusion: </strong>The need factor of frailty was most strongly associated with increased prehabilitation utilization. The variation in utilization by predisposing factors (eg, race) and enabling factors (eg, county-level social deprivation) suggests potential disparities.</p><p><strong>Impact: </strong>The findings describe prehabilitation use in a large cohort of fee-for-service Medicare beneficiaries. Although services seem to be targeted to those at greater risk for adverse outcomes and high spending, potential disparities related to access warrant further examination.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877661","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":"Influence of Race and Ethnicity on Application to Doctor of Physical Therapy Programs.","authors":"Nicole Tombers, Rachel Pfeifer, Kaitlyn Froemke","doi":"10.1093/ptj/pzae184","DOIUrl":"https://doi.org/10.1093/ptj/pzae184","url":null,"abstract":"<p><strong>Objective: </strong>This study uses data from the Physical Therapist Centralized Application Service (PTCAS) to compare influences on application to Doctor of Physical Therapy (DPT) programs between White applicants and people of color (POC) - applicants who identified as Black, American Indian, Asian, Hispanic, or Pacific Islander.</p><p><strong>Methods: </strong>This is a retrospective study using holistic narrative analysis. PTCAS data for the 2020 to 2021 application cycle were obtained, including essays and demographic data. Random samples were drawn such that 736 total applicants to PTCAS were included: 372 White applicants and 364 POC applicants. Using categories previously described in the literature, 3 reviewers coded application essays into as many influence categories as applied. Interrater reliability was evaluated on a sample of 12 essays, using Cohen kappa between reviewer pairs and a total arithmetic mean. Chi-square was used to test for difference between groups, based on Bonferroni correction.</p><p><strong>Results: </strong>Personal experience with physical therapy (53.8% for White applicants, 54.9% for POC applicants), observation of the field (68.5% for White applicants, 71.2% for POC applicants), and alignment with values and interests (62.9% for White applicants, 67.3% for POC applicants) were the most common influences. Applicants of color were more likely to indicate a desire to bring services back to their community of origin, formative experience in health care based on race, and paid work experience in the field. Interrater reliability was excellent (.869).</p><p><strong>Conclusion: </strong>Applicants in the POC group were primarily influenced toward pursuing DPT education by personal interaction with physical therapy and alignment of the field with their values. They were more likely than their White peers to have racially based health care experiences, paid work in the physical therapy field, and a desire to provide services to their community.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882623","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}