The Journal of Clinical Education in Physical Therapy

Effectiveness and efficiency of patient care while enrolled in an orthopedic physical therapy fellowship program

Susan L. Edmond, Julie Whitman, Mark Werneke, Jason Rodeghero — Tue, 10 Sep 2024 00:00:00 +0000

Rationale: Post-professional orthopedic manual physical therapy education programs have proliferated, in part due to increasing therapist demand. Despite the time, effort, and money required to complete these programs, there is scant research addressing their impact.

We investigated whether physical therapists enrolled in an accredited manual physical therapy fellowship program achieved better outcomes, determined by patient changes in function, number of physical therapy visits, and episode of care duration while enrolled in the program. We also examined whether outcomes varied by clinician demographics, clinician life circumstances, and clinic characteristics.

Methods: Forty-two therapists contributed patient data addressing functional status, number of visits, and episode of care duration. We compared data from the first 30 patients with data from the last 30 patients seen by each therapist while enrolled in the program. We also surveyed therapists regarding their demographics, life circumstances, and clinic characteristics.

Results: There were no clinically meaningful or statistically significant differences in change in functional status when comparing results from the first 30 patients with the last 30 patients seen by therapists. However, there was a significant reduction in the number of visits and episode of care duration. Outcomes were influenced by entry-level degree and the presence of children at home.

Conclusion: In our study, enrollment in a physical therapy fellowship program did not improve patient functional status but did reduce the number of visits and episode of care duration. Outcomes were influenced by some clinician life circumstances and clinic characteristics.

Physical therapy students’ perceived levels and sources of stress during clinical education experiences

Lisa L. Dutton, Christina Anderson — Mon, 21 Oct 2024 00:00:00 +0000

Purpose: Stress has been linked to poor performance and mental health disorders in health professions students. Very little is known about health professions students’ stress during clinical education. The purpose of this study was to explore the levels and sources of stress experienced by Doctor of Physical Therapy (DPT) students during the clinical education portion of their curriculum.

Methods: In this cross-sectional, descriptive study, 925 first-, second-, and third-year DPT students from eight Midwestern colleges and universities were invited to complete an electronic survey during a clinical experience. The survey included demographic information, the 10-item Perceived Stress Scale (PSS), and the Undergraduate Sources of Stress (USOS) scale.

Results: The response rate was 28% with a total of 259 returned surveys. The mean PSS score was 14.15 out of a possible 40, with a range from 0 to 30. There were significant differences in levels of stress based on program year and clinical level. No significant differences in level or sources of stress were noted based on gender or clinical setting. Academic sources were the greatest source of stress reported. Amount of student debt and percentage of responsibility for graduate education were significantly correlated with financial sources of stress.

Conclusion: Participants in this study reported mean PSS scores during clinical education experiences similar to those previously reported for physical therapy. Identifying perceived stress levels, sources of stress, and mitigating factors has the potential to improve the health of students and positively impact patient care.

Physical therapy students’ experiences of inappropriate patient sexual behavior: a narrative review

David Smelser — Fri, 16 Aug 2024 00:00:00 +0000

Primary objective: The purpose of this study is to identify the extent to which inappropriate patient sexual behavior (IPSB) is directed toward student physical therapists (PTs) and how this phenomenon is described in the current literature.

Review type: Narrative review.

Summary of review method: A search of PubMed, CINAHL Plus, and Academic Search Complete was conducted using the Boolean phrase (‘sexual harassment’ OR ‘sexual assault’ OR ‘inappropriate sexual behavior’ OR ‘sexual behavior’) AND (‘physical therapy’ OR physiotherapy OR ‘physical therapist’ OR physiotherapist). After relevant articles were identified, references were searched for additional relevant material. Data and common themes were identified, extracted, and summarized.

Primary results: Studies indicate that 84% to 92.9% of PTs have IPSBs directed at them during their careers. There is less information on the rate at which student PTs are targets of IPSB, but the available studies indicate 66.2% to 78% of them experience IPSB during their clinical experiences. In one study, over 22% of PT students experienced severe forms of IPSB during clinical experiences. Other studies show that student PTs and novice PTs respond to IPSB with techniques that are less effective than those used by experienced PTs. Qualitative reports indicate that student PTs feel that they and their clinical instructors are unprepared for IPSB and believe more training on the topic is necessary.

Conclusion: The available literature indicates that most PT students have IPSB directed at them during their clinical experiences. Students report feeling unprepared and desire more training on this topic. Additional training may reduce IPSB.

Agreement between vestibular elective physical therapy students and experienced physical therapists in identifying nystagmus during positional testing and diagnosing benign paroxysmal positional vertigo (BPPV)

Laura P. Kennedy-Rynne, Anne K. Galgon — Thu, 02 May 2024 00:00:00 +0000

Purpose: The aim of this study is to measure the effectiveness of a vestibular elective in preparing students to perform nystagmus identification and diagnosing benign paroxysmal positional vertigo (BPPV) through an investigation of agreement between student performances and experienced physical therapists.

Methods: Seven students watched eye movement videos during positioning testing of 14 patients. Students recorded the nystagmus characteristics for each position and made diagnoses. The students completed additional surveys. Pairwise percent agreement and kappa statistics (κ) were used to compare agreement between each students’ conclusions to those of an experienced physical therapist obtained from a previous study. Krippendorff’s alpha (α) was used to analyze the overall reliability of student ability for these skills.

Results: Interrater agreement between students and the expert was fair to almost perfect (κ = 0.22 to 1) in identifying nystagmus, and slight to almost perfect (κ = −0.02 to 1) in diagnosing BPPV. There was moderate agreement between students to identify nystagmus (α = 0.58–0.65, average agreement = 80–83%) during positional testing, and fair to moderate agreement to diagnose BPPV (α = 0.38 to 0.53, average agreement = 64–74%). Agreement was higher in cases of typical BPPV presentations. Students reported the task as difficult, had the necessary knowledge, and wanted more practice. Correlations (r = 0.76 to 0.82) were seen between clinical experience with BPPV and lower perceived difficulty.

Conclusion: Students are capable of identifying nystagmus and diagnosing typical BPPV; however, students may require more practice, clinical experience, and mentorship to improve reliability. The results may help determine educational needs to prepare clinicians to manage individuals with BPPV.

Professional quality of life and organizational support: a survey of physical therapists with experience as clinical instructors

Andrea Mierau — Mon, 29 Apr 2024 00:00:00 +0000

Purpose: The purpose of this study was to determine the professional quality of life (ProQoL) of physical therapists (PTs) with experience as a clinical instructor and identify factors associated with compassion satisfaction, burnout, and secondary traumatic stress.

Methods: This study used a cross-sectional design and survey methodology. Participants were clinician PTs who have been clinical instructors, and completed an online survey that included the ProQoL scale, the eight-item Survey of Perceived Organizational Support, and demographics.

Results: Of the 259 participants who completed the survey, the majority experienced average to high levels of compassion satisfaction and low levels of burnout and secondary traumatic stress. Chi-square tests of independence indicated high ratings of compassion satisfaction were associated with the uppermost years licensed as a PT, years of clinical teaching experience, and age. Participants aged 26–35 or with less than 5 years of clinical instruction experience correlated with low ratings of compassion satisfaction. Participants with more than 25 years of experience as PTs correlated with low ratings of burnout. High levels of compassion satisfaction were associated with high levels of perceived organizational support.

Conclusion: Findings may assist clinical sites and site coordinators of clinical education in selecting and training clinical instructors.