Bruce Greenfield

Advancements in Contemporary Physical Therapy Research: Use of Mixed Methods Designs

The purpose of this article is to advocate for the use of mixed methods designs in contemporary physical therapist research. Mixed methods designs are used for collecting, analyzing, and mixing both quantitative and qualitative data in a single study or series of studies to both explain and explore specific research problems, thereby enriching the breadth and depth of understanding phenomena. These designs are particularly well suited for physical therapist researchers to reveal the complexity of disablement, rehabilitation, and recovery processes. Although contextual factors influence a persons health condition and recovery, they remain empirically less understood and underexplored by physical therapist researchers. To address this gap, the authors describe various combinations of quantitative and qualitative methods and data within a single study or set of related studies and the decisions that underlie the uses of these combinations. They include examples from current physical therapist research and applications from the International Classification of Functioning, Disability and Health (ICF) model. They argue that the rigorous application of quantitative and qualitative methods and data can propel physical therapist research and practice forward by stimulating new research questions, creating a holistic understanding of patient injury and rehabilitation, and contributing to innovative, complex treatment interventions.

Understanding the lived experiences of patients: application of a phenomenological approach to ethics.

This perspective article provides a justification, with an overview, of the use of phenomenological inquiry and the interpretation into the everyday ethical concerns of patients with disabilities. Disability is explored as a transformative process that involves physical, cognitive, and moral changes. This perspective article discusses the advantages of phenomenology to supplement and enhance the principlist process of ethical decision making that guides much of contemporary medical practice, including physical therapy. A phenomenological approach provides a more contextual approach to ethical decision making through probing, uncovering, and interpreting the meanings of “stories” of patients. This approach, in turn, provides for a more coherent and genuine application of ethical principles within the “textured life-world” of patients and their evolving values as they grapple with disability to make ethical and clinical decisions. The article begins with an in-depth discussion of the current literature about the phenomenology of people with disability. This literature review is followed by a discussion of the traditional principlist approach to making ethical decisions, which, in turn, is followed by a discussion of phenomenology and its tools for use in clinical inquiry and interpretation of the experiences of patients with disabilities. A specific case is presented that illustrates specific tools of phenomenology to uncover the moral context of disability from the perspective of patients. The article concludes with a discussion of clinical, educational, and research implications of a phenomenological approach to ethics and clinical decision making.

The meaning of caring in five experienced physical therapists

Caring has been identified as a desirable indicator of professional behavior in the physical therapy profession and as a necessary value for good patient care. Yet caring is an elusive concept with multiple meanings. The present aim was to describe the nature of caring in the clinical practice of five experienced physical therapists. Purposive sampling was used to recruit five experienced physical therapists. Each physical therapist underwent a series of in-depth, open-ended interviews that were transcribed and coded for themes based on similarities and differences. The analysis resulted in three themes: ethics of caring, risks and conflicts of caring, and learning to care. The data indicated for four of the five participants that caring constituted an ethics of practice or moral orientation. Their moral orientation influenced moral judgment that was integrated throughout their clinical and ethical decision-making practice. The findings stress the difficulty of caring in a managed care health care environment that results in conflicting demands for physical therapists to care for their patients in a system that increasingly values cost control and profit margin. However, the findings also describe the ultimate rewards associated with the practice of an ethics of caring in physical therapy practice.

The influence of cephalostatic ear rods on the positions of the head and neck during postural recordings

This study examined the effect of cephalostatic ear rods on the positions of the head and neck. The method error was assessed for postural recordings of the head and neck position made with and without ear rods. A photographic angle was correlated with the postural angles on x-ray film. The material compared 33 dental students who were recorded with ear rods in and with ear rods out. Subjects were chosen randomly to repeat the postural recordings. The differences between the mean for each postural variable were subjected to comparative analysis, using Students t test for paired samples. A significant difference (p less than or equal to 0.05) was found between the means of the inclination of the cervical spine to the true horizontal and the means of the photographic angle. The mean values for the remaining postural variables showed an insignificant but consistent pattern of axial extension of the cervical spine. Cephalostatic ear rods may alter head and neck position during postural recordings. The method error made for recording total head and neck position with ear rods was higher than without ear rods. The difference in the photographic angle was found to have a moderate positive correlation with the difference in the cervical inclination and the total head and neck position. These data suggest that lateral cephalostatics without ear rods may be used to record total head and neck position and the photographic technique may be used as a quick, inexpensive method for the clinician to determine head and neck positional changes before and after treatment.

Meaning of Caring to 7 Novice Physical Therapists During Their First Year of Clinical Practice

Background and Purpose: Caring has been identified as a rules-based approach to good patient care, as a core value in physical therapist professional behavior, as a part of experienced and expert practice, as a virtue, and as a moral orientation. Previous research showed that experienced and expert female physical therapists value compassion and caring in clinical practice. However, little is known about how novice physical therapists care for their patients. The purpose of this study was to explore the meaning of caring from the perspectives of novice physical therapists. Subjects: Seven novice physical therapists (with less than 1 year of clinical experience) working in either an outpatient or an inpatient facility were recruited. Methods: A qualitative method (phenomenology) was used, with data being obtained from retrospective interviews of the novice physical therapists regarding their experiences in the clinic. Results: Three common themes relating to the nature of caring emerged: learning to care (with the following subthemes: barriers to caring, the “difficult” patient, finding a balance, and time constraints), patients as subjects, and the culture of the clinic. Discussion and Conclusion: The novice physical therapists in this study expressed difficulty in dealing with difficult patients, with time management, and with balancing their professional and personal lives. However, despite the barriers to caring, many of these participants viewed caring not just as a rules-based approach but as a core value and, in some cases, a moral orientation that guided their first year of clinical practice. The findings suggest that caring requires certain skills and attitudes that accrue over time and that physical therapist education programs should integrate learning experiences (including clinical experiences) throughout the curriculum that foster caring behaviors in order to prepare students for the first-year transition in the clinic. In addition, experienced clinicians should appreciate how their clinics culture and their behaviors can help model caring attitudes in novice physical therapists.

Ethics education: developing habits of mind through the use of pedagogical content knowledge

Abstract This article questions our basic assumptions and approaches to ethics education in the health professions. Across the health professions, there is increased need for health professionals to carry out their moral duties in individual patient care, as well as collaborate, as part of an interprofessional team that is grounded in a sense of purpose to the common good in health care. We believe that to be ethically engaged is to be committed to ethically care for patients mindful of their needs, values and goals, attuned to their illness experiences, and emotionally open to their suffering. Students need to be skilled in ethical reasoning and decision-making as a core element of professional competence. In this article we use a model of pedagogical reasoning and action to uncover the critical teaching and learning issues that are part of facilitating students’ development of habits of mind and ethical competence. We further argue that the tools phenomenology, narrative thinking and the development of meta-cognitive skills are fundamental parts of the pedagogical content knowledge that is essential in teaching and learning in ethics.

Phenomenology as a philosophical orientation for understanding the transformative experience of disabling illness.

Abstract Kaufman’s ground-breaking work in the 1980s introduced the phenomenology of disability. In my commentary, I describe phenomenology as a philosophy of understanding the world around us and as a methodology for understanding the lived experiences of patients with life-changing disabilities. Like Kaufman, my focus for the use of phenomenology in health care is to capture the existential and transformative experience of illness. As such, I agree with Kaufman that phenomenology can help health care professionals expand their understanding of patient experiences to provide a fuller and richer, holistic response to care.

The Role of Emotions in Ethical Decision Making: Implications for Physical Therapist Education

Background and Purpose. Competence and commitment to ethical practice is fundamental to the professional development of physical therapist students. Recent research in neuroethics and ethical decision making has illustrated the importance of emotions in moral behavior and ethical decision making. The purpose of this paper is to highlight and explore the importance of emotions in making ethical decisions and to advocate for a role of emotional considerations in physical therapist education program curricula. Position and Rationale. Increased education in the role of emotions in moral behavior and ethical decision making should be a priority for physical therapists and students enrolled in physical therapist professional education programs. The rationale for this position is based on contemporary theories of bioethics and recent research in neuroethics that has uncovered the nexus between emotions and reason that results in caring and empathetic ethical decision making. This position is consistent with A Normative Model of Physical Therapist Professional Education. That document lists caring and compassion as primary values for professional development of physical therapists. Recommendations. Faculty involved in professional physical therapist education need to consider what implications including emotions in ethical decision making could have for physical therapist practice and education. This paper provides some strategies of learning experiences that facilitate emotional reflection in ethical decision making and that may be integrated into a preexisting curriculum.

Education Research in Physical Therapy: Visions of the Possible

Education research has been labeled the “hardest science” of all, given the challenges of teaching and learning in an environment encompassing a mixture of social interactions, events, and problems coupled with a persistent belief that education depends more on common sense than on disciplined knowledge and skill. The American Educational Research Association specifies that education research—as a scientific field of study—examines teaching and learning processes that shape educational outcomes across settings and that a learning process takes place throughout a persons life. The complexity of learning and learning environments requires not only a diverse array of research methods but also a community of education researchers committed to exploring critical questions in the education of physical therapists. Although basic science research and clinical research in physical therapy have continued to expand through growth in the numbers of funded physical therapist researchers, the profession still lacks a robust and vibrant community of education researchers. In this perspective article, the American Council of Academic Physical Therapy Task Force on Education Research proposes a compelling rationale for building a much-needed foundation for education research in physical therapy, including a set of recommendations for immediate action.

Ethical Issues in Sports Medicine: A Review and Justification for Ethical Decision Making and Reasoning

Ethical issues present a challenge for health care professionals working with athletes of sports teams. Health care professionals—including the team physician, the physical therapist, and the athletic trainer—are faced with the challenge of returning an athlete to competition as quickly as possible but as safely as possible. Conflicts of interest arise due to conflicting obligations of the team physician to the athlete and other members of the sports organization, including coaches and the team owner. The multiple stakeholders involved in sports teams challenge the traditional notion of confidentiality and autonomy. The aims of this article are to explicate the ethics of sports medicine, highlight the ethical issues, and provide some strategies and suggestions for ethical decision making.