Faculty Bibliography

OBJECTIVE:The purpose of this study was to create a Site of Excellence in Clinical Education (SECE-PT) tool with the essential criteria used to determine excellence in the provision of physical therapist clinical education at a clinical site using a consensus-building approach. METHODS:The development of the SECE-PT tool was divided into 2 parts. Part 1 involved the development of an initial set of proposed criteria, whereas part 2 employed a modified Delphi approach for consensus building. Purposive selection and snowball sampling techniques were used to recruit clinical instructors, recent graduates, site coordinators of clinical education, and directors of clinical education who met the inclusion criteria for the modified Delphi study. Three web-based survey rounds were used to achieve consensus, defined as a mean score of ≥7 on the 11-point Likert scale. The first round gathered demographic information on participants and collected information about clarity and redundancy in the criteria provided, the second gathered information once again about clarity and redundancy on the revised criteria provided, and the third asked participants to rate how essential it was for a site of excellence to demonstrate each of the final criteria. RESULTS:A total of 123 participants, equally representing clinical and academic perspectives, completed the demographic survey and round 1. Ninety-four participants completed round 2, and 80 participants completed the third and final round. Consensus revealed that 44 criteria were deemed essential for a SECE-PT to demonstrate. CONCLUSION/CONCLUSIONS:This study provides a measure to evaluate clinical sites providing clinical education. The SECE-PT tool should be widely adopted to evaluate the quality of the clinical site providing the education to student physical therapists. IMPACT/CONCLUSIONS:The SECE-PT tool can be used by clinical sites for self-assessment to examine aspects of their clinical education programs and determine whether parts of their program should be further developed. This can provide a framework for discussion and collaboration between clinical and academic partners, as well as regional consortia.

Purpose:The purpose of this observational study was to assess the validity of the Lung Flute (LF) manufacturer's criterion for effective use of the device.
Method(s):Peak expiratory flow (PEF) and the ability to activate the oscillatory mechanism in the LF were assessed and compared. The diagnostic accuracy of the manufacturer's PEF threshold value of >=128.4 L/min was determined, and an optimized threshold was derived.
Result(s):The LF manufacturer's PEF threshold value of >=128.4 L/min had a sensitivity of 100%, a specificity of 55%, and overall diagnostic accuracy of 83%. Nine (45%) of the twenty subjects that were not capable of activating the oscillatory device had a PEF >=128.4 L/min. The optimal threshold value, with a sensitivity and specificity of 100%, for our sample was 167.5 L/min.
Conclusion(s):The manufacturer's PEF threshold value of >=128.4 L/min demonstrated high sensitivity but low specificity for predicting a patient's ability to use the LF device effectively. The optimized threshold value derived from our study was markedly higher. Clinicians should be aware that the LF manufacturer's specifications for the minimum PEF required for effective use of the device may not be evidence-based or accurate and consider this when prescribing this oscillatory positive expiratory pressure device.
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Background/UNASSIGNED:To consistently prepare physical therapist (PT) students for the first full-time clinical experience, the entry-level curriculum must provide and assess competency in the essential knowledge, skills, attitudes and professional behaviors. Objective/UNASSIGNED:The purpose of this Delphi study was to develop consensus on a core set of elements that should be demonstrated by PT students prior to entry into their first full-time clinical experience. A second aim was to obtain the recommended competency levels and assessment methods. Design/UNASSIGNED:The study was conducted using the Delphi method. Methods/UNASSIGNED:Purposive selection and snowball sampling techniques were used to recruit clinical instructors, recent graduates, directors or academic coordinators of clinical education, and academic faculty. Four web-based survey rounds were used to achieve consensus, defined as agreement among ≥ 80% of respondents. The first round gathered demographic information on respondents and identified elements that were deemed essential, the second collected information about clarity and redundancy in the elements provided, the third asked participants to rank their agreement with elements and themes, and the fourth gathered the level of competency that PT students should demonstrate prior to beginning a first full-time clinical experience. Results/UNASSIGNED:Consensus revealed 95 elements, categorized under 14 themes, which were deemed essential for readiness for the first clinical experience. Levels of competency for each element were identified. Limitations/UNASSIGNED:Participants may not have represented all academic programs, practice settings and geographic locations. Conclusion/UNASSIGNED:This study identified the specific knowledge, skills, attitudes, and professional behaviors that all PT students in the United States need to demonstrate competency in prior to the first clinical experience, regardless of school or setting, which would allow learning experiences to be tailored appropriately.

BACKGROUND: Most early mobility studies focus on patients on mechanical ventilation and the role of physical and occupational therapy. This Performance Improvement Project (PIP) project examined early mobility and increased intensity of therapy services on ICU patients with and without mechanical ventilation. In addition, Speech-Language Pathology rehabilitation was added to the early mobilization program. OBJECTIVE: 1. To assess the efficacy of early mobilization of patients with and without mechanical ventilation in the intensive care units (ICUs) on length of stay (LOS) and patient outcomes. 2. To determine the financial viability of the program. DESIGN: PIP. Prospective data collection in 2014 (PIP) compared to a historical patient population in 2012 (pre-PIP). SETTING: Medical and surgical ICUs of a Level 2 trauma hospital. PATIENTS: 160 in the PIP and 123 in the pre-PIP. INTERVENTIONS: Interprofessional training to improve collaboration and increase intensity of rehabilitation therapy services in the MICU and SICU for medically appropriate patients. MEASUREMENTS: Demographics; intensity of service; ICU and hospital LOS; medications; pain; discharge disposition; functional mobility; average cost per day. MAIN RESULTS: Rehabilitation therapy services increased from 2012 to 2014 by approximately 60 minutes per patient. The average ICU LOS decreased by more than 20% from 4.6 days (pre-PIP) to 3.8 days (PIP) (p=.05). A decrease of 30% was observed in the floor bed average LOS from 6.0 days (pre-PIP) to 3.4 days (PIP) (p<.01). An increased percentage of PIP patients, 40.5%, were discharged home without services compared to 18.2% in the pre-PIP phase (p<.01). Average cost per day in the ICU and floor bed decreased in the PIP group resulting in an annualized net cost savings of $1.5 million. CONCLUSIONS: The results of the PIP indicate that enhanced rehabilitation services in the ICU is clinically feasible, results in improved patient outcomes, and is fiscally sound. Most early mobility studies focus on patients on mechanical ventilation. The results of this PIP project demonstrate that there are significant benefits to early mobility and increased intensity of therapy services on ICU patients with and without mechanical ventilation. Benefits include reduced hospitalization LOS, decreased health care costs and decreased need for post-acute care services.

PURPOSE: The purpose of this learning activity is to provide information regarding the differentiation between pressure ulcers and acute skin failure (ASF) in critically ill patients. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Describe the purpose, methodology and impact of this research.2. Differentiate the pathophysiology of pressure ulcers and ASF.3. Identify risk factors and diagnostic criteria for ASF. ABSTRACT: To develop a statistical model to predict the development of acute skin failure in patients admitted to the intensive care unit (ICU) and to validate this model.Retrospective case-control, logistic regression modeling552 ICU patientsIntensive care unit patients with and without pressure ulcers (PrUs) were studied and compared on key variables sorted into the following categories: (1) disease status, (2) physical conditions, and (3) conditions of hospitalization.The variables, peripheral arterial disease (odds ratio [OR], 3.8; P = .002), mechanical ventilation greater than 72 hours (OR, 3.0; P < .001), respiratory failure (OR, 3.2; P < .001), liver failure (OR, 2.9; P = .04), and severe sepsis/septic shock (OR, 1.9; P = .02), were found to be statistically significant and independent predictors of acute skin failure in ICU patients. These variables created a predictor model for acute skin failure in the ICU.Lack of objective criteria to define acute skin failure presents a clinical conundrum for practitioners-the acknowledgment that skin failure exists, but no clear-cut diagnostic criteria in which to support its existence as a result of a paucity of empirical evidence. In certain populations, such as the critically ill patient, the phenomenon of acute skin failure may be occurring, and with the current level of evidence, these ulcers may be incorrectly identified as PrUs. Accurately distinguishing risk factors that lead to a PrU from factors that result in a lesion due to acute skin failure is crucial in the quest to provide evidence-based practice to patients.

BackgroundAcute care physical therapists are at risk of developing work-related musculoskeletal disorders (WMSDs) due to manual patient handling. Safe patient handling (SPH) reduces WMSDs caused by manual handling.ObjectiveThe purpose of this study was to describe the patient handling practices of acute care physical therapists and their perceptions regarding SPH. Additionally, this study determined if a SPH program influences the patient handling practices and perceptions regarding SPH of acute care physical therapists.MethodsSubscribers to the electronic discussion board of American Physical Therapy Association's Acute Care Section were invited to complete a survey questionnaire.ResultsThe majority of respondents used SPH equipment and practices (91.1%), were confident using SPH equipment and practices (93.8%), agreed that evidence supports the use of SPH equipment and practices (87.0%) and reported the use of SPH equipment and practices is feasible (92.2%). Respondents at a facility with a SPH program were more likely to use SPH equipment and practices (P=.020), have received training in the use of SPH equipment and practices (P=.000), agree that the use of SPH equipment and practices was feasible (P=.029) and feel confident using SPH equipment and practices (P=.001).LimitationsThe study might not reflect the perceptions and practices of the population of acute care physical therapists.ConclusionsAcute care physical therapists are trained to use SPH equipment and practices, use SPH equipment and practices, and have positive perceptions regarding SPH. Acute care physical therapists in a facility with a SPH program are more likely to use SPH equipment and practices, receive training in SPH equipment and practices, and have positive perceptions regarding SPH. Quasi-regulatory organizations should incorporate SPH programs into their evaluative standards.

Background and Purpose. Clinical education experiences (CEEs) provide physical therapist (PT) students with opportunities to be immersed in clinical practice to develop professional skills and behaviors under the supervision of a clinical instructor (CI). Essential characteristics and qualities of CIs and of the clinical practice environments in which CEEs take place that promote student learning are clearly described in the literature and in professional documents. However, there are currently wide variations in the quality of CEEs. Factors that appear to contribute to this variability include the CIs' teaching skills, the culture of the clinical site, and supports extended by physical therapist (PT) education programs. The purpose of this paper is to define the baseline qualifications and essential characteristics of CIs and of practice environments that our profession should consider as standards for clinical education and to make recommendations for changes that are needed to promote consistently high quality CEEs. Position and Rationale. It is our position that all stakeholders in clinical education need to engage in a deliberate effort to ensure that all students have access to quality CEEs that demonstrate agreed upon, evidence-based professional standards. We propose that the development of CIs is analogous to the development of a skilled PT, such that CIs move from being novice to expert clinical teachers. Clinical instructors and clinical education sites should be assessed in a standardized manner and the results shared across PT education programs education programs to cultivate high quality CEEs. Directors of clinical education (DCEs), working together through regional consortium, can meet the identified professional development needs of CIs and of center coordinators of clinical education (CCCEs) in an efficient and timely manner. Furthermore, we recommend that the expert CI be recognized as a clinical education specialist in the same way other specialists are recognized by the American Board of Physical Therapy Specialties (ABPTS). Physical therapist education programs, clinical education sites, and the profession at large must acknowledge the benefits of quality CEEs and assume responsibility to foster the development of expert CIs and of learning environments conducive to student learning. Discussion and Conclusion. Physical therapist education programs and clinical sites need to be held accountable to ensure that evidence-based and agreed upon standards for CEEs are available to all students. This will require negotiation and compromise by administrators at both settings. National-level discussion is required to develop a strategic plan to determine how these recommendations might be implemented so that professional standards for all CEEs are realized.