Jill D. Black

Student Experiences in Creating and Launching a Student-Led Physical Therapy Pro Bono Clinic: A Qualitative Investigation

Background The physical therapy profession has called for the provision of pro bono services. Little is known about the impact on students involved in sustainable pro bono leadership. One physical therapy program established a pro bono physical therapy clinic under the direct leadership of a board of students. Objective The purpose of this study was to describe the experiences of the inaugural members of the Chester Community Physical Therapy Clinic Student Board in creating and launching the student-led pro bono physical therapy clinic. Methods A purposive sample of the 18 members participated in semistructured interviews. Content analysis was conducted using a commercially available software program. Trustworthiness was enhanced with credibility, transferability, and confirmability. Results The emergent categories were: (1) leadership skill development, (2) competency in hands-on clinical and administrative skills, and (3) commitment to both the community and the clinic. Pride emerged as a strong and overarching theme throughout the experience. Conclusions The student-led pro bono clinic meets several Commission on Accreditation in Physical Therapy Education criteria in a sustainable manner and serves as a means for measuring and meeting program mission and goals. Participation in the program was a meaningful experience and developed ownership, leadership skills, and pride among the students. There are also possibilities for expanding aspects of the program so that all physical therapist students can benefit from pro bono service opportunities.

Effectiveness of Exercise for Managing Osteoporosis in Women Postmenopause

<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence resource on a single topic and will present clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on exercise for the management of osteoporosis in women postmenopause. Which, if any, approaches to exercise reduce loss of bone mineral density or reduce the chance of fractures in women who are healthy postmenopause? A 2003 report from the Surgeon General of the United States estimated that 10 million individuals had osteoporosis and almost 34 million had low bone mass, placing them at increased risk for osteoporosis.2 Analysis of data from people with 6 to 7 years of Medicare coverage in the United States in 2005 estimated the prevalence of osteoporosis to be approximately 30%.3 The major outcome of concern in osteoporosis is minimal trauma fracture. This is a type of fracture resulting from injury that would be insufficient to fracture normal bone and are referred to as low-impact fracture, fragility fracture, and osteoporotic fracture.4 One study estimated that by 2025, osteoporotic fractures will grow to more than 3 million, incurring

Proposed Guidelines for International Clinical Education in US-Based Physical Therapist Education Programs: Results of a Focus Group and Delphi Study

25.3 billion in costs.5

Barriers to Bicycle Helmet Use in Young Children in an Urban Elementary School

Background Physical therapist students are increasingly engaging in international clinical education (ICE). The growth of international engagement has been accompanied by appeals to ensure that these experiences are conducted in an ethical manner. Although detailed guidelines have been developed to guide global health training in general, they do not specifically address all aspects relevant to ICE in physical therapist education. Objective The purpose of this study was to systematically develop recommendations for the implementation of ICE in physical therapist education to promote ethical practice. Methods An initial virtual focus group of 5 physical therapist faculty with expertise in ICE provided input to review and revise global health training guidelines previously developed by non–physical therapists. The revised guidelines were distributed to a pool of 19 physical therapist faculty with ICE experience for additional review and revision through 3 online Delphi survey rounds. Results The participants accepted 31 of the original guidelines with or without revisions, rejected 2 guidelines, and developed 10 new guidelines or subguidelines. Most notably, they rejected a guideline related to students pursuing training outside of a structured program, stressing that ICE should never be done outside of a formal program. Limitations The primary limitation is that the study included only faculty from sending institutions and thus lacked the voices of the host institutions, students, partner organizations, or funders. Conclusions This study systematically produced guidelines for ICE in physical therapist education using a range of ICE experts from sending institutions. The recommendations may be used by educators and other decision makers to optimally design new ICE opportunities or to improve existing ones. Additional validation should be done to ensure relevance for all stakeholders.

Exploring international clinical education in US-based programs: identifying common practices and modifying an existing conceptual model of international service-learning

Purpose. Traumatic brain injury is a leading cause of death in bicycle crashes. The factors associated with bicycle helmet use in young children with diverse ethnic and socioeconomic backgrounds have not been studied. The purpose of this study was to identify barriers to helmet use in young children in an urban elementary school. Design. Qualitative content analysis with semistructured interviews, observational field notes, and artifacts. Setting. Urban elementary school. Participants. Seventeen students whose age ranged from 5 to 7 years and whose ethnic background was identified as African American (14) or Caucasian (3). Method. Children participated in a brain safety fair that included presentations and activities. Semistructured, pre- and postexperience interviews were completed. Observations of the students participating in the activities and reflective art projects from the students were collected. Results. The analysis found the following barriers to helmet use: (a) lack of access to a helmet, (b) poor fit of helmets due to hairstyles, and (c) lack of knowledge regarding helmet use. Conclusion. The present study suggests that the issue of helmet design and comfort for younger children with variable hairstyles needs to be addressed in order to increase helmet use in this population.

Benefits and challenges of international clinical education from a US-based physiotherapist faculty perspective.

Abstract Background: Increasingly physical therapist students complete part of their clinical training outside of their home country. This trend is understudied. The purposes of this study were to: (1) explore, in depth, various international clinical education (ICE) programs; and (2) determine whether the Conceptual Model of Optimal International Service-Learning (ISL) could be applied or adapted to represent ICE. Methods: Qualitative content analysis was used to analyze ICE programs and consider modification of an existing ISL conceptual model for ICE. Fifteen faculty in the United States currently involved in ICE were interviewed. The interview transcriptions were systematically analyzed by two researchers. Results: Three models of ICE practices emerged: (1) a traditional clinical education model where local clinical instructors (CIs) focus on the development of clinical skills; (2) a global health model where US-based CIs provide the supervision in the international setting, and learning outcomes emphasized global health and cultural competency; and (3) an ICE/ISL hybrid where US-based CIs supervise the students, and the foci includes community service. Additionally the data supported revising the ISL model’s essential core conditions, components and consequence for ICE. Conclusions: The ICE conceptual model may provide a useful framework for future ICE program development and research.

Geriatric Screening as an Educational Tool: A Case Report

INTRODUCTION The influence of internationalization on physiotherapist education in at least North American-based programmes has become more apparent. Faculty and students have been involved in various international activities. One category of activities includes international clinical education (ICE), where students earn clinical education credit for their learning activities at international sites. Although this educational strategy appears to be increasingly used in at least the United States and Canada, the related literature is limited in scope. The purpose of this portion of the present study was to investigate the benefits and challenges of ICE for US-based students, US-based physiotherapy programmes and international partners from the perspective of US-based faculty sending students for clinical education internationally. METHODS Content analysis was used for this qualitative study. Fifteen US-based faculty members who had experience in sending physiotherapist students for ICE were recruited. The primary researcher conducted semi-structured phone interviews, averaging approximately 60 minutes in length. The primary and secondary researchers completed data analysis using NVivo 8 software (QSR International Inc., Cambridge, MA). RESULTS Benefits of ICE to the students included exposure to alternate health systems, broadening of student perspectives and clinical competence. Challenges consisted of funding and possible language barrier. Increased visibility, expanded global perspective and faculty collaborations were benefits to the programme. Ensuring a quality learning experience was the greatest programme challenge. Benefits to the international site included education and faculty collaborations/exchanges; challenges were language, student clinical preparation and unfamiliarity with the student evaluation tool. Because the sample was limited to 15 US-based faculty members, the results may not be relevant to all programmes inside or outside of the United States. Additionally, the study lacked perspectives from the students or international sites. IMPLICATION FOR PHYSIOTHERAPY PRACTICE The present study is an early step in the important examination of the impact of this emerging educational trend on physiotherapy education and practice.

Therapistsʼ Perspectives and Interventions in the Management of Axillary Web Syndrome: An Exploratory Study

Background and Purpose. The American Geriatrics Society and the American Physical Therapy Association (APTA) Section on Geriatrics (now known as the Academy of Geriatric Physical Therapy) released essential competencies for practitioners working with older adults to address the aging population. Experiential learning is an important component of physical therapist education to reinforce concepts learned in the didactic curriculum and provides valuable practice for students. The purpose of this case report is to describe an experiential learning activity that provided first‐year Doctor of Physical Therapy (DPT) students’ opportunities to interact with older adults and perform functional screening activities. Case Description. First‐year DPT students participated in screens at 2 community sites that serve older adults. Students learned about the components of the screen during their “Lifespan Adulthood” class. Components of the screen include demographics, the Functional Comorbidity Index, a Likert‐scale question on Fear of Falling, the Geriatric Depression Scale‐4, and the Short Physical Performance Battery. Students practiced their assigned component in class prior to the screening event. Students performed the screens at the community site with older adult clients and then had to interpret the results of 1 client as a class assignment. Outcomes. Supervising faculty noted that students were able to facilitate the flow of clients from one screening station to the next, guarded appropriately, and provided appropriate client education. Students had challenges with psychomotor tasks (eg, gait speed timing, making initial contact with the older adults) and required guidance when vital signs fell outside of a normal range. Strengths of the interpretation assignment included thorough literaturebased rationale for screening and description of the individual components of the screen. Students experienced challenges with identifying the overall functional picture of a particular client based upon the completed screening data. Discussion and Conclusion. This screening event addressed components of the Academy of Geriatric Physical Therapy essential competencies. Adding reflection pieces and additional practice time may improve interpretation of screening. However, the students’ interpretation matched their skill level as first‐year DPT students. Progression through the didactic and clinical education curriculum will further reinforce essential competencies.

The clinical relevance of phenomenology in today’s evidence-based world

Background: Axillary cording or axillary web syndrome (AWS) is a condition that may manifest after surgical interference in the axillary lymph nodes. AWS can cause significant impairments and has been treated with physical and occupational therapy. Little is known about the pathophysiology of AWS or about the therapeutic interventions that are most effective. The purpose of this study is to explore the perspectives and preferred interventions of physical and occupational therapists from a particular region, experienced in treating AWS. Methods: Qualitative methodology was used to explore the practices of 7 therapists with experience treating AWS. The participants were interviewed and their intervention techniques video recorded for content analysis. Results: Five physical therapists and two occupational therapists from one region were interviewed and their intervention techniques video recorded. Results showed that the therapists differed in opinion on the pathophysiology of the condition but shared many similarities in treatment approaches. Video recordings captured specific techniques that can further inform therapeutic practice. Conclusions. AWS is a condition seen in women after surgical treatment for breast cancer. Unlike previous literature accounts, the participants in this study do not think that the condition spontaneously resolves. Intervention can successfully manage the condition and restore functional, painfree use of the upper extremity. AWS is a condition that should be recognized by all therapists and additional study should be done to determine precise pathophysiology and best practices in intervention.

Curricular Integration and Measurement of Cultural Competence Development in a Group of Physical Therapy Students.

The value of phenomenologically-informed inquiry in physical rehabilitation as discussed by Dr Papadimitriou in Physical Therapy Reviews sheds an important light on components related to physical therapy practice that have not traditionally received critical attention. As we read and process the information related to the phenomenologicallyinformed approach, the analysis of the data excerpt, and the relative value of such an approach for clinical practice, we are reminded of the three central aspects of evidence-based medicine as described by Sackett and colleagues: (1) best research evidence; (2) clinical expertise; and (3) patient values. Our physical therapy literature is growing rapidly with information for demonstrating best evidence and informing clinical expertise; but in comparison, our wealth of knowledge in the area of patient values has not kept sufficient pace. The literature around clinical expertise has grown and depicts the importance of reflective practice in becoming an expert, a component that presented itself in Dr Papadimitriou’s work and is a tenet in the phenomenological approach. We concur that incorporation of the phenomenological approach will enhance the efficacy of the physical therapy interaction and move us further in evidence-based practice as it calls for consideration of the client’s perspective, the client’s context, and reflective practice. Dr Papadimitriou’s clinical example illustrates the importance of context in client-centred care and recognizing patient values for evidence-based practice. A multitude of context specific elements including those related to the patient or client, the therapist, the therapist’s work environment, and the client’s work and home environments can be explored and considered within the frame of the phenomenologically-informed approach. Greenfield and Jensen applied a phenomenological approach to ethical decision-making in physical therapy, contrasting the traditional process dominated by fact-finding and objectivity with an alternative approach that recognizes the unique perspectives and experiences of individuals with disabilities. Such a phenomenological approach can be informative for clinical decision-making as well. Greenfield and Jensen make the same argument as Papadimitriou proposes, urging therapists to be reflective and clientcentred as we interpret meaning within the therapy experience. They identify clinical knowledge as a particular construct that is often ‘tacit or implicit’ and suggest the phenomenological approach offers a connection between the patient experience and our decision-making. We found Dr Papadimitriou’s initial description of the therapist and client encounter to be ‘clinical’ in nature, resembling the traditional pursuit of objective client data. In contrast, the qualitative data provided through observation, field notes, and reflective journaling reveal a richer context. This illustrates how the therapist pursues objective data, but must also explore client context and practice self-reflection. The author’s carefully identified personal biases and positionality, further model good practice for physical therapists. While the excerpt the author presented included an impromptu interview with the therapist, we found ourselves looking for more data from the client’s viewpoint. A phenomenological interview with the client would have provided a balance for analysis of the interaction. The excerpt presented whets our appetite to know more about previous interactions. The encounter had many complexities despite its brevity and may or may not be reflective of other encounters between the two. This emphasizes the need for ongoing and continual data gathering and data interpreting to further guide inquiry and reminds us as therapists to continue to assess and reassess our interactions with clients. The phenomenological approach prompts us to identify how the derived meanings can be further explored and also provides guidance for future encounters that foster client-centred care. Of central concern in this scenario is the client’s motivation (or lack of motivation) to maximize function after injury. The therapist is likely considering decisions regarding strategies for therapeutic interventions, methods for client/ family/caregiver education, and plans for community Correspondence to: J. D. Black, Institute for Physical Therapy Education, Widener University, One University Place, Chester, PA 19013, USA. Email: jblattanzi@mail.widener.edu