Donald H. Lein

A Model to Integrate Health Promotion and Wellness in Physical Therapist Practice: Development and Validation

Background Globally, physical therapy professional organizations have called for physical therapists to perform lifestyle behavior management during customary care, or health‐focused care, due to increasing morbidity and mortality related to noncommunicable diseases. Given the potential for health‐focused care to improve health outcomes, physical therapists should integrate health promotion into their daily clinical practice. A clinical model that illustrates necessary steps to deliver health‐focused care would be helpful to educate present and future physical therapists. Objective The purpose of the study was to develop and validate the Health‐Focused Physical Therapy Model (HFPTM) for physical inactivity and smoking. Methods The authors used a mixed method approach. The preliminary model was informed by previous research and the investigators’ shared experience in health promotion and physical therapy. An interdisciplinary group of health professionals provided input into the preliminary model by way of a World Café format. Eight physical therapists with health promotion and education expertise then engaged in a Delphi process to establish content validity. Results World Café participants indicated that: (1) physical therapists are well positioned to engage in health promotion and wellness, and (2) the model facilitates interdisciplinary collaboration and consultation. Delphi process participants reached majority consensus in 1 round. The average model content validity index (CVI) was .915 for physical inactivity and .899 for smoking. Agreement concerning the model schematic was 88% for either behavior. Investigators made few editorial changes after the Delphi process. Limitations Limitations of this study include using only 2 unhealthy lifestyle behaviors for testing, and performing the testing in a nonclinical setting. Conclusions An interdisciplinary group of health professionals believes that physical therapists should practice health‐focused care and that the HFPTM is a valid model. This model could help physical therapist educators when educating physical therapist students and clinicians to practice health‐focused care.

Evaluation of Three Osteoporosis Prevention Programs for Young Women: Application of the Health Belief Model.

Purpose: The purpose of this study was to evaluate the effectiveness of theory-based osteoporosis prevention programs on calcium and vitamin D intakes and osteoporosis health beliefs in young women. Methods: Women (N = 152) aged 19 to 25 years were randomly assigned to one of 3 groups: a brochure group (n = 51), a computer-tailored program group (n = 51, and the same computer-tailored program (n = 50) with brief verbal feedback. Participants completed surveys regarding osteoporosis beliefs prior to and immediately after assigned intervention. They also completed surveys measuring osteoporosis behaviors before and 1 month after intervention. Results: Participants (n = 152) in all groups significantly improved calcium intakes from baseline to 1 month after interventions. All groups experienced significant decreases in perceived barriers to obtaining adequate vitamin D and significant increases in perceived osteoporosis susceptibility and severity. Discussion: Interventions that delivered osteoporosis material via a brochure or tailored computerized messages with or without brief feedback from a health professional were successful. These changes may be due to theory-based components of the interventions. Translation to Health Education Practice: Though future research is needed, this study holds promise for health education practice to use health behavior theory to plan cost-effective osteoprotective programs for young women.

Cross-validation of the Student Perceptions of Team-Based Learning Scale in the United States

Purpose The purpose of this study was to cross-validate the factor structure of the previously developed Student Perceptions of Team-Based Learning (TBL) Scale among students in an entry-level doctor of physical therapy (DPT) program in the United States. Methods Toward the end of the semester in 2 patient/client management courses taught using TBL, 115 DPT students completed the Student Perceptions of TBL Scale, with a response rate of 87%. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were conducted to replicate and confirm the underlying factor structure of the scale. Results Based on the PCA for the validation sample, the original 2-factor structure (preference for TBL and preference for teamwork) of the Student Perceptions of TBL Scale was replicated. The overall goodness-of-fit indices from the CFA suggested that the original 2-factor structure for the 15 items of the scale demonstrated a good model fit (comparative fit index, 0.95; non-normed fit index/Tucker-Lewis index, 0.93; root mean square error of approximation, 0.06; and standardized root mean square residual, 0.07). The 2 factors demonstrated high internal consistency (alpha= 0.83 and 0.88, respectively). DPT students taught using TBL viewed the factor of preference for teamwork more favorably than preference for TBL. Conclusion Our findings provide evidence supporting the replicability of the internal structure of the Student Perceptions of TBL Scale when assessing perceptions of TBL among DPT students in patient/client management courses.

Impact of Varying the Parameters of Stimulation of 2 Commonly Used Waveforms on Muscle Force Production and Fatigue.

STUDY DESIGNnLaboratory-based experimental study using a repeated-measures design.nnnOBJECTIVESnTo determine the effect of varying stimulation parameters of burst-modulated alternating current (BMAC) and pulsed current (PC) on quadriceps femoris muscle force output and fatigue.nnnBACKGROUNDnThe impact of altering stimulation parameters on muscle force and fatigue using PC has been well described; however, less is known regarding BMAC.nnnMETHODSnQuadriceps femoris muscle force was measured during a series of neuromuscular electrical stimulation-induced muscle contractions, with varying combinations of pulse duration and frequency, using PC or varying duty cycles and burst frequencies using BMAC. Additionally, muscle fatigue tests were conducted bilaterally with different stimulation waveforms and parameters.nnnRESULTSnFor PC, the product of pulse duration and frequency was strongly predictive of muscle force output (R(2) = 0.85, P<.05). When using BMAC, the duty cycle was a strong predictor of force output (R(2) = 0.91, P<.05). Altering the frequency during BMAC had no effect on muscle force production, as opposed to the classic force-frequency relationship consistently observed with PC. Waveform type significantly impacts muscle fatigue, the BMAC resulted in a more rapid rate of fatigue irrespective of stimulation frequency, and it was confirmed again that lower frequencies of PC result in less fatigue during repeated muscle contractions.nnnCONCLUSIONnIn this study, altering the burst frequency of BMAC did not influence muscle force or fatigue, whereas the duty cycle significantly impacted muscle force production. Frequency of PC impacted both force and fatigue as expected, demonstrating increased muscle force and fatigue with increased frequency.

Evaluation of a Computer-Tailored Osteoporosis Prevention Intervention in Young Women

Purpose The purpose of this study was to evaluate the effectiveness of a theory-based computer-tailored osteoporosis prevention program on calcium and vitamin D intake and osteoporosis health beliefs in young women. Additionally, this study tested whether adding bone density testing to the intervention improved the outcomes. Methods One hundred (n = 100) women aged 19 to 25 years were randomly assigned to one of 2 groups. One group (n = 50) received the computer-tailored program with brief counseling and the second group (n = 50) received the same intervention plus bone density testing of the heel (quantitative ultrasound [QUS]) feedback. Results Participants within both groups statistically significantly increased calcium and vitamin D intake from baseline to 1 month after the interventions. Both groups also experienced statistically significant decreases in perceived barriers to obtaining adequate vitamin D intake. Discussion The theory-based computer-tailored osteoporosis prevention program resulted in significant improvements in osteoporosis beliefs and calcium and vitamin D intakes. The bone density test did not improve results. Translation to Health Education Practice Though future research is needed, this preliminary study holds promise for health education practice to use theory to plan osteoprotective computer programs for young women.

Evaluation of team-based learning in a doctor of physical therapy curriculum in the United States

Purpose The purpose of this retrospective study was to evaluate students’ academic outcomes after implementation of the team-based learning (TBL) approach in patient/client management courses in an entry-level doctor of physical therapy (DPT) curriculum. Methods The research design of this study involved comparing written and practical exam scores from DPT student cohorts taught with the traditional instructional methods (lecture-based) to those of students from subsequent cohorts taught using the TBL approach in two patient/client management courses: basic skills and cardiopulmonary. For this comparison, the exams used, the number of contact hours and labs, and the instructors who taught these courses remained the same during the transition between these two instructional methods (traditional vs. TBL). The average of all individual course exam scores was used for data analysis. Results In both courses, there were no meaningful differences in the mean exam scores among students across years of cohorts receiving the same instructional method, which allowed clustering students from different years of cohorts in each course receiving the same instructional method into one group. For both courses, the mean exam score was significantly higher in the TBL group than in the traditional instruction group: basic skills course (P<0.001) and cardiopulmonary course (P<0.001). Conclusion Student cohorts taught using the TBL approach academically outperformed those who received the traditional instructional method in both entry–level DPT patient/client management courses.