Carol Figuers

The predictive value of selected job rewards on occupational therapists' job satisfaction in ambulatory care settings.

Using a perceived reward model of overall job satisfaction, this study utilized a correlational research design with multiple regression analysis to determine the predictive power of extrinsic rewards and intrinsic rewards, collectively and individually, as determinants of overall job satisfaction among registered occupational therapists (OTR) working full-time in ambulatory care settings. The intrinsic rewards (task involvement and task autonomy), collectively and individually, were perceived to be significant overall job satisfaction determinants. General working conditions was the only significant extrinsic reward. Given the demand for OTRs in ambulatory care settings, a better understanding of factors that influence overall job satisfaction among OTRs could prove beneficial in developing appropriate recruitment and retention job design strategies.

NONSURGICAL MANAGEMENT OF PELVIC FLOOR DYSFUNCTION

In the 50 years since pelvic muscle exercises were introduced for the nonsurgical management of pelvic floor dysfunction related to parturition, a variety of approaches have been introduced and the scope of indications has grown. This article describes the evaluation of patients with pelvic floor complaints, discusses additional techniques for performing pelvic muscle exercises including biofeedback and electrical stimulation, details a comprehensive educational program, and examines the literature on the use of pelvic muscle exercises for the treatment of stress and urge urinary incontinence.

Survey on Curricular Content for Doctor of Physical Therapy Guidelines for Womenʼs Health Content in Professional Physical Therapist Education: 2014 Update

Objective:To conduct a survey using evidence from community stakeholders in order to update the Doctor of Physical Therapy Guidelines for Womens Health Content in Professional Physical Therapist Education (Guideline). Study Design:Survey research report. Background:The original content Guideline was published in 2005 with expectations that it would be updated every 5 years. A task force appointed in 2011 undertook this work. Methods and Measures:A survey was developed and fielded electronically to all 202 accredited academic programs in December 2011. A modified academic survey was fielded to the clinical community. The clinician survey was sent electronically to 1951 members of the Section on Womens Health in April 2012. Analysis of results and percent agreement were used to define elements included in the updated Guideline. Results:There was a high agreement on content to be taught in Doctor of Physical Therapy entry-level curricula. Response rate was 102 (51%) for the academic survey and 340 (17%) for the clinician survey. Areas with equivocal input were evaluated by the task force. Conclusion:Key stakeholder input attained via survey data assisted the task force in its efforts to produce the Doctor of Physical Therapy Guidelines for Womens Health Content in Professional Physical Therapist Education: 2014 Update.

Technical Report on Using the Systems and Patient Management Model in Womenʼs Health DPT Curricular Guidelines

Background:The Board of Directors of the Section on Womens Health of the American Physical Therapy Association appointed a task force to provide an update to the 2005 “Guidelines for Womens Health Content in Professional Physical Therapist Education” (2005 Guideline) using best evidence and clinical expertise. Study Design:The task force developed and implemented a survey to all accredited physical therapy education programs in the United States as well as all womens health (WH) certified physical therapists. Survey data and qualitative data from facilitated discussion were analyzed, prioritized, and organized into an updated version of the Guideline. Case Description:The task force based the updated WH curricular guideline on both systems and patient-client management models. Outcome:The updated Guideline includes the following systems: cardiopulmonary, endocrine, gastrointestinal, immune, integumentary, musculoskeletal, neurologic/psychological, reproductive, and urogynecologic. In addition, each condition was organized using the patient-client management model, with key content knowledge or skill paired with educational objectives that could be incorporated into course syllabi. Key content areas also include the level of competence expected of an entry-level student. Discussion:The updated Guideline should serve as a comprehensive resource for all providers of WH curricular content.

Physical Therapist Interventions for Voiding Dysfunction and Pelvic Pain: A Retrospective Case Series

BackgroundMany women experience debilitating symptoms of voiding dysfunction and pelvic pain, leading to limitations in daily living. Physical therapist interventions for voiding dysfunction and pelvic pain are noninvasive, multimodal, and patient-specific. This study reviews the efficacy of physical therapy interventions in treating symptoms of voiding dysfunction and pelvic pain. Study DesignThis is a retrospective chart review of 5 female patients referred from urogynecology to Womens Health Physical Therapy. Indications for referral included urinary retention, chronic pelvic pain, recurrent urinary tract infections, and levator ani spasm. Interventions included bladder training, pelvic floor relaxation, biofeedback, manual therapy, vaginal scar massage, and instructions for internal self-massage. Case DescriptionMean age was 52 years (range, 20-80). Mean duration of symptoms at the onset of therapy was 13 years (range, 2-25). Each patient was evaluated and treated on an individual basis by using a wide range of physical therapist interventions. Outcome measures of change in pain and functional limitation scores were measured. OutcomesOn a scale of 0 to 10, with 10 being the greatest pain, initial mean pain score was 5.3, and the mean at completion of therapy was 1.3. Functional limitation described by patients (range from 0%, no limitation, to 100%, complete limitation) improved from a mean of 75% to 40%. Three patients required self-catheterization at the onset of therapy; at discharge, 2 no longer required catheterization, and the third reduced from 12 to 3 times daily. The mean number of visits for the 5 patients was 7 (range, 3-15), with treatment duration ranging from 10 to 16 weeks. DiscussionVoiding dysfunction and pelvic pain symptoms appear to improve in women who adhere to a comprehensive physical therapy plan of care. By combining direct intervention during Womens Health Physical Therapy visits with a regular home exercise program, women in this case review were able to make gains toward symptom resolution.

Pelvic Floor Muscle Activity and Urinary Incontinence in Weight-Bearing Female Athletes vs. Non-Athletes

Objective: The purpose of this study was to compare pelvic floor muscle activity and frequency of urinary incontinence (UI) in female athletes to that of female non‐athletes. Study Design: The research design was quasiexperimental without random assignment of subjects. Background: Millions of women, including young athletes, report urinary incontinence. Previous research indicates that elite, weight‐being athletes report greater incidence of incontinence when compared with agedmatched female non‐athletes. Methods and Measures: Females aged 18 to 25 years were recruited into 2 groups based on weekly exercise time and athletic involvement; participants in a NCAA Division I sport (n=56), and female non‐athletes (n=75). Pelvic floor muscle activity, measured via surface electromyographic (EMG) electrodes, was recorded during the execution of a pelvic floor muscle contraction by each subject. Subjects also completed questionnaires regarding frequency of UI. Descriptive statistics were compiled for both groups, and data were analyzed with parametric and nonparametric tests. Results: There was no significant difference in pelvic floor muscle activity between groups. Athletes reported significantly greater frequency of experiencing UI with exercise than non‐athletes (p < .001). Athletes also reported significantly greater exercise time per week than non‐athletes (p < .001). Both groups reported a greater frequency of UI with greater exercise time. Conclusions: Although there was no significant difference in pelvic floor muscle activity between athletes and non‐athletes, the athletes did report a greater frequency of UI with exercise. Athletes also reported significantly greater exercise time. This suggests that pelvic floor muscle activity alone does not predict UI and that activity related to incontinence should also be considered. Future studies may focus on the role of increasing pelvic floor muscle strength to prevent urinary incontinence in female athletes.

Comparison of Section on Womenʼs Health, American Physical Therapy Association, Guidelines for Womenʼs Health Content in Professional Physical Therapist Education; 2005 to 2014

Background:A task force of the Section on Womens Health of the American Physical Therapy Association developed guidelines for womens health (WH) curricular content in entry-level physical therapy (PT) programs, published in 2005 and an updated version completed in 2014. The results from faculty and clinician respondents informed both versions. This article compares the survey tools, the survey results, and the subsequent guidelines. Study Design:Comparative report. Methods and Outcomes:A cutoff score of 75% from a faculty and clinician survey ruled in areas of practice included in the 2005 Guideline. A cutoff score of 70% from an original survey to both faculty and clinicians was used to determine curricular items included in 2014. One category (polycystic ovary disease) was deleted from the 2014 Guideline. Ten new categories, including bowel and colorectal cancer, chronic fatigue syndrome, gallbladder issues in pregnancy, and thromboembolic events in obstetric clients, were added in 2014 Guideline. The 2014 Guideline was organized by system and subdivided into common diagnoses and pathologies, whereas the 2005 Guideline was formatted similar to the Normative Model for Physical Therapist Education. Information regarding the WH content that was being taught in entry-level PT curricula 10 years ago compared with present day is noted in this Guideline comparison. Discussion:The differences in content categories between the 2 versions of the Guideline may be explained by changes in clinical practice and by the differences in the surveys used. The 2014 Guideline should assist faculty in updating WH curricular content in entry-level PT programs.

Inter-Rater Reliability and Diagnostic Accuracy of Pelvic Girdle Classification

Body: An Evidence-based Appraisal of Current Literature Regarding the Effects of Exercise on Bone Mineral Density in Postmenopausal Women with Low Bone Mass. Purpose/Hypothesis: Adolescent obesity is a strong predictor of obesity into adulthood. Health concerns on obesity in adolescence warrants further investigation. Longitudinal research on health perceptions and activity patterns associated with obesity in females is limited. The aim of this 3 part study was to compare a body image perception profile (BIPP), perceived health status and activity patterns in females, in two body mass index (BMI) categories, over time. Number of Subjects: 1,326. Materials/Methods: Study utilized 2x2 split-plot ANOVAs and Chi-Square tests as analysis of data from the National Longitudinal Study of Adolescent Health. Female participants were categorized as either high BMI ((H)BMI) or low BMI ((L)BMI). The cut-off values for (H)BMI were set at ≥23kg/m for teens and ≥25kg/m for adults. Participants were randomly selected for the study as adolescents and re-assessed about 6 years later. For inclusion, the participants had to be categorized into the same group at both time periods. Results: Study 1 (BIPP analysis): For indicator 1 (pride), the interaction was significant (p=.023). Simple effects revealed that pride significantly improved into adulthood within both groups (p≤.0005). In the adult group, the (H)BMI group showed significantly more pride (p=.019). For indicator 2 (weight), the (H)BMI group had a significantly higher perception of weight status regardless of time (p≤.0005) and subjects’ self-perception of weight increased over time regardless of group (p≤.0005). Correlations between weight perception and BMI were significant for all sub-groups; (H)BMI teens had the lowest correlation (r=.279). For indicator 3 (acceptance), the (H)BMI group had lower self-acceptance regardless of time (p≤.0005) and the subjects’ self-acceptance improved over time regardless of group (p≤.0005). Study 2: The (H)BMI group had a lower perception of health regardless of time (p≤.0005) and the subjects’ perception of health improved over time regardless of group (p≤.0005). Study 3: The proportion of (H) and (L)BMI individuals engaged in activities (sedentary and active) were significantly different (p=.012 to p≤.0005). Conclusions: The study found female adolescents who were categorized as (H)BMI had a weaker association between actual BMI and perceived weight status. Also, individuals with higher BMIs expressed lower self-acceptance and perception of health regardless of time. In adulthood, greater differences were found in the activity pattern analysis as compared to adolescence; the (H)BMI group spent proportionally more time in sedentary activities. Overall, these findings provide evidence that BMI status is associated with differing activity patterns and are linked to perceptions of body image and health. Clinical Relevance: Our goal as physical therapists is to provide female adolescents who are overweight/obese with exercise prescriptions for a more active lifestyle. Through education, exercise, and wellness interventions, physical therapy may prevent obesity and its adverse consequences on health and perceptions of self-acceptance into adulthood. TITLE: Normative Data on Knee Valgus Angle, Lower Extremity Strength, and Bone Mineral Density in Postmenopausal Women Lisa Mazzini, Erika Honour, Neisha Wetzel, Sue Schuerman, Beth Altenburger INSTITUTIONS (ALL): 1. Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA. Purpose/Hypothesis: To: 1) determine if a relationship exists between static knee valgus angle in standing, dynamic knee valgus angle with a