Joyce R. Maring

Acting on Reflection: the Effect of Reflection on Students’ Clinical Performance on a Standardized Patient Examination

BackgroundLittle evidence exists to support the value of reflection in the clinical setting.ObjectiveTo determine whether reflecting and revisiting the “patient” during a standardized patient (SP) examination improves junior medical students’ performance and to analyze students’ perceptions of its value.DesignStudents completed a six-encounter clinical skills examination, writing a guided assessment after each encounter to trigger reflection. SPs evaluated the students with Medical Skills and Patient Satisfaction checklists. During the last three encounters, students could opt to revisit the SP and be reevaluated with identical checklists.ParticipantsOne hundred and forty-nine third year medical students.MeasurementsChanges in scores in the Medical Skills and Patient Satisfaction checklists between first visit and revisit were tested separately per case as well as across cases.ResultsOn the medical skills and patient satisfaction checklists, mean revisit scores across cases were significantly higher than mean first visit scores [12.6 vs 12.2 (pooled SD = 2.4), P = .0001; 31.2 vs 31.0 (pooled SD = 3.5), P = .0001)]. Sixty-five percent of the time, students rated “reflect–revisit” positively, 34% neutrally, and 0.4% negatively. Five themes were identified in the positive comments: enhancement of (1) medical decision making, (2) patient education/counseling, (3) student satisfaction/confidence, (4) patient satisfaction/confidence, and (5) clinical realism.ConclusionsOffering third year medical students the option to reflect and revisit an SP during a clinical skills examination produced a small but nontrivial increase in clinical performance. Students perceived the reflect–revisit experience as enhancing patient-centered practices (counseling, education) as well as their own medical decision making and clinical confidence.

Presentation and Progression of Friedreich Ataxia and Implications for Physical Therapist Examination

Friedreich ataxia, although rare, is the most prevalent inherited ataxia. Recent insight into the disease pathogenesis is creating new hope for effective therapies. The purposes of this update are: (1) to review the etiology, presentation, and progression of Friedreich ataxia and (2) to describe a comprehensive physical therapist examination emphasizing valid and reliable performance measurements associated with disease progression. Early identification of individuals with Friedreich ataxia and precise characterization of impairments and functional limitations gain importance as new drug therapies are considered.

Concurrent validity of the Early Intervention Developmental Profile and the Peabody Developmental Motor Scale-2.

Purpose: The purpose of this study was to determine the concurrent validity of the Early Intervention Developmental Profile (EIDP) and the Peabody Developmental Motor Scale-2 (PDMS-2) in examining gross motor delay. Methods: Thirty children with a variety of developmental delays attending an early intervention program were administered both the PDMS-2 and the EIDP as part of their developmental evaluations. Results: The PDMS-2 and EIDP were strongly correlated (r = 0.91, p < 0.01) but the mean age equivalent scores were significantly different. Age equivalent scores were on average 26% higher on the EIDP. Conclusions: Differences in age equivalent scores between tests may affect a child’s eligibility for services in some states. This study supports the use of norm-based tests when determining a percentage of delay relative to the norm. Developmental tests should not be the sole determinant of the clinical decision making processes.

Characterizing gait, locomotor status, and disease severity in children and adolescents with Friedreich ataxia.

Background and Purpose: The purpose of this study was to describe gait parameters in children and adolescents with a diagnosis of Friedreich ataxia (FA) and examine the relationship between disease severity, measured by the Friedreich Ataxia Rating Scale (FARS) and gait parameters. The study examined whether FARS scores can discriminate between those who walk independently and those who require assistance. Methods: Thirty-eight children (aged 5-11 years) and adolescents (aged 12-17 years) with genetically confirmed FA were divided into two groups based on locomotor status: group 1, subjects who were able to walk independently, and group 2, subjects who required assistance for walking. Temporal and spatial gait parameters were collected using the Stride Analyzer computerized foot switch system and compared with age-matched normative data. The FARS was used to measure disease severity. Correlation coefficients and the Mann-Whitney U test of differences were used to evaluate associations and discern differences between groups. Results: In subjects with FA, gait parameters of velocity and cadence were slower and stride length was shorter compared with age-matched children without disabilities. These parameters were significantly correlated with FARS score (r = 0.696, 0.667, 0.537; respectively, all P values <0.001). Total FARS scores were correlated with locomotor status (ç value r = 0.623; P < 0.01) and could categorize subjects into groups based on independent walking or need for assistance, 73% and 87% of the time, respectively. Discussion and Conclusion: Subjects with FA exhibited specific abnormal gait characteristics relative to age-matched individuals. Disease severity, as measured by the FARS, was associated with gait velocity, stride length, and cadence. FARS scores can be used to categorize subjects by locomotor status and may be a useful screening tool to identify those requiring assistance.

Validating Functional Measures of Physical Ability for Aging People with Intellectual Developmental Disability.

Unlike the aging population without intellectual and developmental disabilities (IDD), few standardized performance measures exist to assess physical function and risk for adverse outcomes such as nonfatal, unintentional injuries. We modified 3 selected standardized performance tools in the areas of general fitness (2-Minute Walk Test), balance and gait (Performance-Oriented Mobility Assessment I), and functional independence (Modified Barthel Index) for administration with people with IDD. The modified tools were piloted with 30 participants. Results indicated the measures are strongly associated and successfully distinguished between participants with an adverse health event in the previous year. The modified tools have potential to provide clinicians with quantitative measures that track physical performance changes associated with aging in people with IDD.

Perceived effectiveness and barriers to physical therapy services for families and children with Friedreich ataxia.

Purpose: To describe the frequency, type, and perceived effectiveness of physical therapy interventions for children with Friedreich ataxia (FA); identify barriers to therapy; and solicit advice from parents. Method: Parents of 30 children with FA participated in semistructured interviews. Qualitative and quantitative methods were used to analyze the data. Results: Sixty-seven percent of children received direct physical therapy service. Stretching and strengthening exercises were used most frequently, and their perceived usefulness increased as the children aged. Seventy-three percent received home exercise programs; 9% implemented these consistently. External barriers included a lack of expert providers and limited reimbursement. Internal barriers included limited time and energy, lack of awareness of services, and childrens preferences not to be treated differently. Parents advised therapists to become experts, advocates, and use approaches based on family and child preferences. Conclusions: Outcomes provide a starting point for developing further research, education, and effective interventions for children with FA.

Education Program and Student Characteristics Associated With Pass Rates on the National Physical Therapy Examination for Physical Therapist Assistants

Background and Purpose. An important program outcome for physical therapist assistant (PTA) education programs is the pass rates of PTA graduates on the National Physical Therapy Examination (NPTE). The purposes of this study were to: (1) examine the relationship between PTA student education program characteristics and PTA graduate pass rates on the NPTE; and (2) develop a model which includes student and programmatic characteristics to predict success on the NPTE. Subjects. Program directors from 50 accredited PTA education programs completed surveys about their program. Methods. Program survey responses were coded and matched with first time and ultimate pass rates on the NPTE obtained from the Federation of State Boards of Physical Therapy (FSBPT). Correlation analyses and regression analyses were performed examining the relationships between NPTE pass rates and survey variables describing student and program characteristics and the role of the variables in predicting program pass rates. Results. Pass rates of PTA graduates were positively correlated with newer, public programs, more clinical education credits, and less general education credits as a percentage of the total credits required for program completion. The model best predicting first time pass rates included the year of program inception, and clinical education credits expressed as a percentage of the total credits. The model best predicting ultimate pass rates included the year of program inception, and whether the institution was public or private. Discussion and Conclusion. Updated curricula that include adequate time for required PTA competencies and the recruitment of qualified students are some factors that may contribute to PTA graduate success on the NPTE. All factors examined in this study need further investigation with a larger sample size.

A Model for Designing a Geriatric Physical Therapy Course Grounded in Educational Principles and Active Learning Strategies

Background and Purpose. The proportion of time physical therapists spend with individuals over 65 continues to grow as the population grays. Education programs must respond to this demand by preparing graduates to meet the complex needs of older persons within the productivity constraints of the current health care environment. This paper describes a model for the development of a dedicated geriatrics course in a Doctor of Physical Therapy program grounded in educational theory to optimize learning and preparedness for geriatric clinical practice. Method/Model Description and Evaluation. The geriatrics course incorporates principles of adult learning, experiential learning theory, reflective practice, and active learning strategies. Professional resources, such as A Normative Model of Physical Therapist Professional Education and Essential Competencies in the Care of Older Adults at the Completion of the Entry‐level Physical Therapist Professional Program of Study described by the APTA Academy of Geriatric Physical Therapy, were used to align course content and objectives with contemporary practice expectations. Learner strategies and course content were further refined using a needs assessment as well as formative and summative feedback from students. Quantitative and qualitative data were collected related to student self‐efficacy; student perceptions of their knowledge, skills, and attitudes; student perceptions of the course; and measures of attainment of course goals. Descriptive statistics were used to summarize quantitative data and the related groups. The Wilcoxon signed‐rank test was used to analyze pre and posttest scores on self‐efficacy scales. Qualitative data were coded and examined for clusters and patterns of meaning. Multiple researchers were used to analyze the raw data, confirm the accuracy of the findings, and search for disconfirming information. Outcomes. Student outcomes demonstrate that the process used in course design was effective. Changes in the pre‐ and post‐test efficacy scale indicated students became significantly more confident in their ability to manage the needs of older patients. Students shared aspects of their experiences that surprised them, assumptions they made, challenges they encountered, strategies used to overcome those challenges, and future learning needs. Students passed course assessments, which were mapped to required competencies. Discussion and Conclusion. A model for designing a focused geriatric physical therapy course grounded in educational principles and active learning strategies was presented. Outcomes indicate students felt more confident and were actively engaged throughout the course. Student feedback and course outcomes indicate students mastered course competencies mapped to contemporary expectations for physical therapist practice. Although this model was applied specifically to a course on physical therapist management of the older adult, the same process can be applied to a broad range of content areas across the continuum of practice. Educational principles and active learning strategies shaped the development of a geriatric physical therapy course that optimized student self‐efficacy, engagement, reflection, and competence in managing the older adult client.

A Course of Its Own: A Stand-Alone Pediatric Course Designed to Meet the Essential Core Competencies and Program Goals

Background and Purpose.Professional physical therapist (PT) education programs must prepare graduates to effectively provide physical therapy for patients throughout the lifespan. A number of models, standards, and competencies are available to guide the development of the pediatric curricular conte

Using a divided-attention stepping accuracy task to improve balance and functional outcomes in an individual with incomplete spinal cord injury: A case report.

ABSTRACT A spinal cord injury (SCI) frequently results in impaired balance, endurance, and strength with subsequent limitations in functional mobility and community participation. The purpose of this case report was to implement a training program for an individual with a chronic incomplete SCI using a novel divided-attention stepping accuracy task (DASAT) to determine if improvements could be made in impairments, activities, and participation. The client was a 51-year-old male with a motor incomplete C4 SCI sustained 4 years prior. He presented with decreased quality of life (QOL) and functional independence, and deficits in balance, endurance, and strength consistent with central cord syndrome. The client completed the DASAT intervention 3 times per week for 6 weeks. Each session incorporated 96 multi-directional steps to randomly-assigned targets in response to 3-step verbal commands. QOL, measured using the SF-36, was generally enhanced but fluctuated. Community mobility progressed from close supervision to independence. Significant improvement was achieved in all balance scores: Berg Balance Scale by 9 points [Minimal Detectable Change (MDC) = 4.9 in elderly]; Functional Reach Test by 7.62 cm (MDC = 5.16 in C5/C6 SCI); and Timed Up-and-Go by 0.53 s (MDC not established). Endurance increased on the 6-Minute Walk Test, with the client achieving an additional 47 m (MDC = 45.8 m). Lower extremity isokinetic peak torque strength measures were mostly unchanged. Six minutes of DASAT training per session provided an efficient, low-cost intervention utilizing multiple trials of variable practice, and resulted in better performance in activities, balance, and endurance in this client.