Laurita M. Hack

Describing Expert Practice in Physical Therapy

In this article, the authors demonstrate how grounded theory may be used to develop models for understanding clinical practice. Through a series of research studies involving novice, experienced, and expert physical therapy practitioners, conceptual frameworks were continually revised based on data obtained from returning to the field and relevant literature available at the time. As concepts and relationships moved to larger themes, a theoretical framework for expertise in clinical practice was proposed. Current work on verifying the theoretical framework continues. Grounded theory is an excellent research approach to bound and help guide a multistage research program involving multiple researchers working in multiple settings.

Factors That Influence the Clinical Decision Making of Physical Therapists in Choosing a Balance Assessment Approach

Background: Many methods for examining patients with balance deficits are supported by the literature. How or why therapists choose specific balance assessment methods during examination of patients remains unclear. Objectives: The aims of this study were: (1) to explore decision making during examination of patients with balance deficits, (2) to understand the selection and use of assessment methods from the clinicians perspective, and (3) to explore why specific methods were selected. Design: A qualitative design using a grounded theory approach permitted exploration of clinical decision making. Methods: Eleven therapists were purposefully selected (6 from outpatient offices, 5 from inpatient rehabilitation settings) to participate in repeated interviews. Credibility of the findings was established through low-inference data, member check, and triangulation among participants and multiple data sources. Results: A highly individualized approach to patient examination based on therapists’ practical knowledge emerged from the data, with limited influence of the literature. Movement observation was the primary assessment and diagnostic tool. When selecting assessment approaches for specific patients, the perceived value of information gathered mattered more than testing time. A 3-stage model of assessment decision making portrayed both the process and reasons influencing therapists’ choices. Conclusions: In the context of the complex and busy nature of clinical practice, therapists gathered data that they considered meaningful during patient examination. The findings provide insight into factors influencing assessment decisions and suggest mechanisms to foster translation of research into clinical practice.

Gait Variability Detects Women in Early Postmenopause With Low Bone Mineral Density

Background Women in early postmenopause and with low bone mineral density (BMD) may exhibit early markers for physical frailty as a result of sarcopenia and osteopenia. Objective The purpose of this study was to determine whether women in early postmenopause and with low BMD exhibit decreased physical performance and differences in gait variability and fall and fracture rates. Design This study was an observational cohort design with participants assigned to groups on the basis of BMD status. Methods Fifty-four women, 31 with low BMD and 23 with normal BMD, participated. This study was conducted in a university research facility. Physical performance was measured by assessment of dynamic balance (timed backward tandem walk test), strength (handheld dynamometry of isometric quadriceps muscle force production), and free gait speed. Gait variability was assessed on the basis of the coefficient of variation for temporal-spatial gait characteristics. Falls and fractures were assessed for the year after initial testing. Results Significant between-group differences were found for step time and stance time variability. Limitations The limitations of this study included group assignment on the basis of the results of the most recent bone density scan within the preceding 2 years. Conclusions Women in early postmenopause and with low BMD exhibited increased gait variability in step time and stance time but did not exhibit differences in balance, strength, or gait speed. Gait variability may be more sensitive for detecting differences in women in early postmenopause and with or without low BMD than more typical measures of physical performance.

Use of a Delphi panel to establish consensus for recommended uses of selected balance assessment approaches.

The Delphi survey is a useful mechanism to make recommendations for clinical judgments in the absence of practice guidelines for evidence-based decision making. Although there is a great deal of literature about the topic of various methods of balance assessment, decisions about application of research evidence for clinical practice may be subject to personal interpretation and/or biases of the reader. In this study, a panel of informed experts was used through a Delphi process to establish consensus regarding the recommended use of selected balance assessment methods based on the literature. Selective recruitment of experienced faculty members with advanced degrees and/or specialist certification in the content area identified seven knowledgeable informants. The panel participated in three rounds of discussion to develop a consensus-based summary of the recommended use of balance assessment methods commonly used in clinical practice and suggest how those measures fit within the framework of the Patient/Client Management Model of physical therapy practice. The outcomes of the Delphi process form a basis for recommended practice in the examination of patients with balance deficits and serve as a starting point in the development of evidence-based practice guidelines.

National Study of Excellence and Innovation in Physical Therapist Education: Part 2—A Call to Reform

This perspective shares recommendations that draw from (1) the National Study of Excellence and Innovation in Physical Therapist Education research findings and a conceptual model of excellence in physical therapist education, (2) the Carnegie Foundations Preparation for the Professions Program (PPP), and (3) research in the learning sciences. The 30 recommendations are linked to the dimensions described in the conceptual model for excellence in physical therapist education: Culture of Excellence, Praxis of Learning, and Organizational Structures and Resources. This perspective proposes a transformative call for reform framed across 3 core categories: (1) creating a culture of excellence, leadership, and partnership, (2) advancing the learning sciences and understanding and enacting the social contract, and (3) implementing organizational imperatives. Similar to the Carnegie studies, this perspective identifies action items (9) that should be initiated immediately in a strategic and systematic way by the major organizational stakeholders in physical therapist education. These recommendations and action items provide a transformative agenda for physical therapist education, and thus the profession, in meeting the changing needs of society through higher levels of excellence.

In Search of Cultural Competence

We have foiled to understand that teachers are first and foremost cultural workers, not neutral professionals exercising pedagogical or psychological skills on a culturally-detached playing field. 1(p306)The winter issue of the Journal of Physical Therapy Education provides several articles that give us an opportunity to reflect on some of the more difficult and complex issues that face physical therapy education.First is an innovative position paper by Wehbe-Alamah and Fry, which describes a model for developing and maintaining a culturally sensitive and welcoming academic environment for students, faculty, and staff of culturally diverse backgrounds. Physical therapy faculty often address the importance of assuring culturally competent behavior in the clinical setting. Wehbe-Alamah and Fry have provided a position paper that shifts the focus to the educational setting, challenging academic educators to evaluate the cultural competence of their own behaviors and environment. Providing a welcoming and culturally sensitive environment to an ethnically and religiously diverse community of learners and staff is becoming an increasingly complex task, as our learners becomeslowly but surely-more diverse in their race, ethnicity, religious affiliations, socioeconomic background, and learning abilities. For some physical therapy faculty, this may mean a wealth of new experiences; while, for many of our students, diversity is representative of their high school and college experiences. Educators across primary, secondary, and higher education have long focused on developing educational institutions and programs designed to provide appropriate educational environments for students of diverse backgrounds. This May 2014 marks the 60th anniversary of the landmark Brown versus the Board of Education Supreme Court decision, which made racial segregation illegal in the United States.Thus, there is potential that our students arrive to physical therapy education with more tolerance for and interest in cultural differences than ever before. Is the diversity gap between our faculty and students a barrier to modeling cultural competence in our academic settings? Wehbe-Alamah and Fry present a model that can assist our generation of teachers to continue this decades-long pursuit of cultural competence in our own clinical and educational practices. If all members of the educational community model a commitment to creating a culturally sensitive learning environment, our students may have more success carrying these values and practices into the clinical setting.Also in this issue, Hinman, Peel, and Price, members and staff of the Commission on Accreditation in Physical Therapy Education, contribute the results of a study of leadership retention in physical therapist (PT) and physical therapist assistant (PTA) programs The findings may not surprise our readership. An invited commentary on this research, by Gordon, provides a suggested position description for the academic leader of a PT program. The findings of this study and the recommended role responsibilities by Gordon will provide those hiring academic leaders and those considering such opportunities with important perspectives to consider. …

Strategies for Using the APTA Section on Research Evidence-Based Practice Curriculum Guidelines

Background and Purpose. The Doctor Of Physical Therapy Education Evidence‐Based Practice Curriculum Guidelines were published in March 2014 by the Evidence Based Practice Special Interest Group (EBP SIG) of the American Physical Therapy Association (APTA) Section on Research. The EBP Curriculum Guidelines describe the recommended minimum standards for EBP terminal behaviors and define common language and content to integrate throughout a physical therapist (PT) education curriculum. The 3 purposes of this paper are to describe (1) a rationale for adoption of the EBP Curriculum Guidelines by academic programs, (2) the process used to create the Guidelines, and (3) strategies for PT education programs to use the Guidelines for curriculum evaluation, student assessment, and faculty assessment and development. Position and Rationale. The EBP Curriculum Guidelines should be considered for adoption by all PT education programs. EBP is an expected and valued skill of PTs. Academic programs have independently determined the breadth and depth of EBP content to integrate into their curricula. EBP paradigms, methods, and resources have evolved over time. The evolution of resources and the variation in program implementation have resulted in variations in curriculum content and student skills. A guideline with expected terminal behavioral objectives and examples of classroom and clinical educational objectives may help to standardize the skill sets of new graduates. Discussion and Conclusion. The development process and structure of the EBP Curriculum Guidelines are described to orient readers to the linked document. Strategies for using the Guidelines for curriculum content evaluation, content mapping, timing and levels of student assessment, academic core faculty and clinical faculty preparation, and overall program outcome assessment are briefly reviewed. This consensus document may change as EBP methods or physical therapy core documents evolve; it currently represents an explicit curriculum guideline appropriate for PT education.

Wisdom and Courage

Laurita M. (Laurie) Hack, DPT, PhD, MBA, FAPTA , has contributed to the physical therapy profession as an educator, researcher, and academic leader (Fig. 1 ).

The Continuing Conversation on Educational Research in Physical Therapy

Journal of Physical Therapy Education 5 Over the past several issues, we have discussed the need to strengthen educational research in physical therapy education. At APTA’s 2016 Combined Sections Meeting, Drs Jan Gwyer, Rick Segal, and Gail Jensen presented views on this topic from the perspectives of JOPTE editor, senior educational researcher, and senior clinical sciences researcher, respectively. They discussed the gaps between what is desired and what is actually happening, along with many suggestions for improvement. Dr Hack then turned to the audience to ask for their suggestions about how to improve the status of educational research in physical therapy education. One hour later, the line at the microphone finally finished! The clearest message was that attendees wanted to gain the skills to be good educational researchers, looked for support from their more senior colleagues, hoped for resources from their colleges and universities, and expected various APTA components (APTA, Education Section, American Council of Academic Physical Therapy) to take leadership roles. Plans are underway for papers on this topic and further conversation at the 2016 Educational Leadership Conference. Watch for news over the coming months on specific actions to help the profession of physical therapy develop the strong educational research program it needs and deserves! —————————-——--—--—--—––––––––– guEsT EDITORIAL –––––––––––-—--—-—-——————-——---

The Challenge of Communication

As educators in physical therapy, we take seriously the goal of developing effective communication skills in our students. Sometimes this simply takes the form of correcting students’ overuse of the word “like” as they speak with their patients. Sometimes our teaching helps students with the complex task of listening for true understanding as they take a patient’s history. This issue of the Journal of Physical Therapy Education (JOPTE) includes 2 papers that address professional communication in challenging situations. Cambier presents a perspective paper that recommends instructional methods for educating students in addressing inappropriate patient sexual behavior in the clinical environment. The Ingram and colleagues study indicates that one-third of physical therapist students report occasions in which their clinical instructors have “badmouthed” a professional colleague in their presence. Inappropriate patient sexual behavior is experienced by a significant number of physical therapists, and it is likely a topic of discussion of many clinicians. Similarly, it is likely that many physical therapist educators are aware of instances of badmouthing. Both of these topics describe very challenging communication scenarios, and ones in which practitioners may rely primarily on their lived experiences as PTs or PTAs to guide their actions with students. The editors invited 2 members of the Editorial Board of JOPTE to write commentaries for the 2 aforementioned papers to extend the discussion of communication in difficult situations. We hope that all physical therapy educators take up the challenge of enhancing their teaching of professional communication in these complex situations. Both of these papers, and the commentaries, will provide a context for important discussions between educators and students. Speaking of communication, we are pleased to have received a letter to the editor about a previously published article, which has allowed the letter writers and the author to clarify information. We hope this inspires more of you to send us letters of clarification, discussion, and further exploration of the ideas presented by our authors. This issue presents a wide range of topics: classroom teaching, clinical teaching, PTA education, international perspectives—demonstrating the breath of physical therapy education. We hope that you find this issue valuable to you in your role as an educator. —————————-——--—--—--—–––––––-––– EDITORIAL –––––––––––––-—--—-—-——————-——-—--