Martha R. Hinman

Interrater reliability of flexicurve postural measures among novice users

Abstract. The purpose of this study was to establish the interrater reliability of the flexicurve when used by novice testersto measure thoracic kyphosis and lumbar lordosis in a community-based population. Three graduate students independentlymeasured 51 healthy women (aged 21 to 88 years). The flexicurve was molded to the contour of the spine and traced onto a plainpiece of paper to calculate the Index of Kyphosis (IK) and Index of Lordosis (IL). Subjects were measured while standing in theirusual relaxed posture and again in their maximally erect posture. Intraclass correlation coefficients (ICCs) were calculated todetermine the reliability among the three testers. IK measures were more reliable than IL measures with ICCs of 0.94 and 0.93for the relaxed and erect postures, respectively. ICCs for the IL were 0.60 when relaxed and 0.73 when maximally erect. Greatervariability in the lumbar measures may be attributed to difficulty in conforming the flexicurve to the smaller, concave curvatureof the lumbar spine and interference from some subject’s clothing. Nevertheless, these findings indicate good reliability forflexicurve measures of thoracic kyphosis and support the use of this measurement when documenting clinical changes in postureor identifying postural abnormalities in community-based screenings.Keywords: Posture, spine, postural assessment, kyphosis, lordosis

Comparison of Two Short-term Balance Training Programs for Community-dwelling Older Adults

Purpose: This study was designed to compare balance performance, perceived benefits, and compliance rates of community‐dwelling older adults who participated in a short‐term computerized balance training program (CBT), a home program of balance exercises (HEP), or no program. Methods: Eighty‐eight subjects were randomly assigned to train interactively on the Biodex Balance System, train at home using an illustrated exercise program, or perform no training for a period of 4 weeks. Pre‐ and post‐test measures included simple reaction time (SRT), timed 50‐foot walk test (TWT), the Berg Balance Scale (BBS), and the Modified Falls Efficacy Scale (MFES). Results: A 3 × 2 analysis of variance (ANOVA) revealed no significant differences in the performance improvements observed among the 3 groups (over time) in any of the measures. Likewise, an independent t‐test showed no difference in compliance rates between the two training groups. Chi‐square analyses of subjective comments indicated that subjects in the CBT group found their training to be more interesting and challenging than those who trained with the HEP. Approximately 20% of subjects in each group reported that their balance had improved. Conclusion: Although compliance was good in both training groups and many subjects perceived an improvement in their balance and/or functional abilities, neither type of short‐term balance training improved performance measures to a significant extent when compared to control subjects.

Changing educational paradigms to prepare allied health professionals for the 21st century

CONTEXT Inefficient and ineffective health care delivery has been of recent concern to most stakeholders in the process. Care provision systems will improve when care providers are educated to function as team members and to demonstrate competencies required for practice in diverse, demanding, and ever-changing environments. GOAL In one School of Allied Health Sciences, faculty members from nine departments united to create an interdisciplinary curriculum designed to foster the achievement of common competencies essential for success in the workplace. APPROACH Members of a Curriculum-2000 Task Force collaborated to: (1) review current literature, (2) articulate a set of common competencies across several disciplines, and (3) produce a proposal for achieving and measuring competencies in an interdisciplinary manner. CONCLUSION Individuals from various disciplines can come to consensus about competencies that graduates should achieve. Such consensus is the first step in the direction of implementing a curriculum based on interdisciplinary competencies.

Comparative effect of positive and negative static magnetic fields on heart rate and blood pressure in healthy adults

Objective: To compare changes in heart rate (HR) and blood pressure (BP) associated with short-term exposure to static magnetic fields (SMFs) of positive versus negative polarity. Design: A double-blind, randomized controlled trial using a time series design. Setting: Physical therapy laboratory in a university setting. Subjects: Seventy-five adults with a mean age of 30.6 years were assigned to one of three treatment groups. No subjects had any symptoms of cardiovascular disease or cardiac irregularity. Interventions: Fifteen-minute exposure to an SMF by lying on a mattress pad containing magnets of positive polarity, negative polarity, or none (placebo). Main outcome measures: HR and BP were monitored prior to exposure, at 1-minute, 5-minute, 10-minute and 15-minute intervals following exposure, and again 5 minutes after exposure. Results: Subjects in all groups demonstrated slight decreases in HR and BP, but none of these changes were associated with the intervention (p = 0.170). Conclusions: Short-term exposure to an SMF of either positive or negative polarity does not appear to cause any clinically meaningful changes in HR or BP among asymptomatic subjects. This finding supports the safe use of unipolar SMFs that contain low-intensity magnets (<1000 gauss) relative to the cardiovascular system.

Functional predictors of stair-climbing speed in older adults.

Background and Purpose:Falls on stairs are a common cause of injury and death among older adults. Although stair climbing is a component of some instruments that assess activities of daily living, normal speeds for safe stairway ambulation have not been established. Furthermore, little is known about which components of functional mobility are most highly associated with stair-climbing speed. The purposes of this study were to determine the range of normal stair-climbing speeds for ambulatory, community-dwelling older adults and identify which functional mobility tests could best explain this speed. Methods:Twenty men and 34 women older than 65 years completed 6 functional mobility tests, including timed heel rises, timed chair stands, functional reach, one-legged stance time (OLST), a timed step test (alternately touching a step 10 times), and self-selected gait speed. Participants were then timed as they ascended and descended a flight of 8 to 10 steps. Combined ascent-descent times were used to calculate stair-climbing speed in steps per second. Stepwise regression techniques determined the best functional predictors for stair-climbing speed. Results:Participants ascended and descended stairs at an average speed of 1.3 steps per second; men tended to ambulate stairs more quickly than women. The best predictors of stair-climbing speed were usual gait speed and OLST (R = 0.79; P = .01), which explained 63% of the variance in stair-climbing speed. Discussion:Our results were similar to others who reported stair-climbing speeds ranging from 1.1 to 1.7 steps per second for older adults. However, the 2 predictors identified in this study provide a simpler and more accurate model for estimating stair-climbing speed than has been previously reported. Further research is needed to determine whether this speed is sufficient for negotiating stairs in an emergency. In addition, further study is needed to determine which tests/measures best differentiate individuals who can and cannot independently climb a typical flight of stairs. Conclusions:An older adults stair-climbing speed can be accurately estimated by using a model that includes his or her usual gait speed and OLST. This information will help health care professionals and directors of residential facilities make appropriate decisions related to living accommodations for their older adult clients.

Computerized exercise program does not affect stress levels of asymptomatic VDT users

The purpose of this study was to determine whether a computerized exercise program could reduce stress levels in office workers who use video display terminals (VDTs). Fifty workers were randomly assigned to either an exercise or a control group. Twenty-four subjects were instructed to exercise twice a day for 15 minutes per session for a period of 8 weeks; the remaining 26 subjects in the control group were given no exercise program. Four dimensions of stress were measured before and after the exercise period using the Personal Strain Questionnaire (PSQ), a self-reported measure of physical and psychological stress. A multivariate T-test (Hotelling’s T2) was used to compare changes in stress levels between the two groups of workers, but no significant differences were found. Further analysis of the exercise group revealed that difference in compliance rates among workers did not significantly influence changes in stress levels. These results indicate that this type of exercise program does not reduce stress in asymptomatic VDT users.

THE THERAPEUTIC USE OF MAGNETS: A REVIEW OF RECENT RESEARCH

Abstract The therapeutic use of magnets to relieve pain and promote tissue healing has been gaining popularity as an alternative/complementary therapy, despite the limited scientific evidence available to support the efficacy and safety of these devices. This article provides an overview of the types of magnets in use and their theoretical effects, along with a summary of the known effects of pulsed electromagnetic fields and a critical review of research studies involving the use of static magnetic fields. The findings of these scientific studies are often conflicting, and suggest the need for larger randomized controlled trials to establish the efficacy of magnet therapy for specific pathological conditions, determine optimal treatment parameters (i.e., type, strength, polarity, and placement of magnets), and identify potential adverse responses.

Leadership Retention in Physical Therapy Education Programs

Background and Purpose. Program leadership is a key to achieving program outcomes and meeting the program’s mission. The Commission on Accreditation in Physical Therapy Education (CAPTE) requires that programs have qualified and effective academic administrators. In recent years, CAPTE has noted a high rate of attrition among academic administrator positions for physical therapist (PT) and physical therapist assistant (PTA) education programs. Therefore, a survey was developed to help identify the reasons program directors were leaving their administrative positions. Subjects. The survey was sent to individuals who had vacated positions as directors of PT or PTA education programs during the 3‐year time period from 2008 to 2011. Seventy‐nine individuals returned surveys for a response rate of 59%. Methods. The survey was developed by the members of CAPTE’s Central Panel. Members of the other 2 panels (PT and PTA) reviewed the survey for clarity and face validity. The survey was sent electronically to former program directors. Survey items included demographic information, institutional classification, years of academic experience, and reasons for leaving an administrative position. Results. Individuals who had directed PT programs comprised 58% of the sample versus 41% who had directed PTA programs (1% directed both). The most frequently cited reasons for leaving administrative positions included: (1) a perceived lack of resources or support from university administration or some type of internal conflict; (2) excessively high/demanding workloads; (3) inadequate compensation; (4) promotion to a higher administrative position; and (5) inability to hire or retain adequate faculty to operate the program. A greater proportion of PT program directors had prior academic experience compared to PTA program directors. Program directors who had at least 5 years of prior academic experience stayed in their administrative positions longer. Individuals who were hired to direct developing programs were less likely to have had prior academic experience than those who were hired to direct established programs, especially in PTA education. Retention was higher at public and nonprofit private institutions compared to proprietary institutions. Discussion and Conclusion. To enhance retention of program administrators, institutions should consider structuring a development program to support program directors; such a program could include formal or informal mentoring, networking with experienced colleagues in similar positions, and regular communication with supervising administrators (deans and/or chairs). Because most PT and PTA program directors enter their administrative positions without any formal management training, continuing education courses or workshops on topics such as strategic and long‐term planning, fiscal and personnel management, and accreditation issues may be particularly beneficial. Prospective program directors may also benefit from exploring the institutional expectations of an administrative position prior to accepting such a position.

Changing Profile of the Physical Therapy Professoriate—Are We Meeting CAPTEʼs Expectations?

Background and Purpose. Changing accreditation standards continue to place greater demands on physical therapy (PT) faculty. The 2016 accreditation standards implemented by the Commission on Accreditation in Physical Therapy Education (CAPTE) include requirements for all core faculty to possess a doctoral degree and show evidence of scholarly productivity. Program directors have additional requirements as does the collective faculty, which must include at least 50% with postprofessional, academic doctorates. This study describes the changing characteristics of the PT professoriate and determines how well it meets CAPTEs current expectations. Participants. The sample included 2,602 full-time core faculty members from 225 educational institutions. Methods. Data from the 2015 Annual Accreditation Report were extracted by staff in the Department of Accreditation; personal and program identifiers were removed. Variables included age, sex, highest earned degree, clinical specialization, faculty role, academic rank, years of academic experience, institutional affiliation, workload distribution, level of scholarly productivity, faculty rank, and institutional classification. Descriptive data were analyzed for the total sample, and chi-square analyses compared differences in scholarly productivity based on sex, faculty roles, academic rank, highest earned degree, and institutional affiliation. A cluster analysis was used to determine the characteristics shared by faculty whose scholarship reflected a high vs. low level of productivity as measured by the number of disseminated, peer-reviewed products. Faculty were also grouped according to the program to determine the percentage of programs that met various CAPTE standards related to credentials and scholarship. Results. Most core faculty were women who averaged 49 years of age and 13 years of academic experience. The most common rank held by 45% of faculty was assistant professor. Faculty spent the greatest amount of time teaching (50%) and the least amount in clinical practice (<6%). Nearly 60% possessed an academic doctorate, and 40% were certified clinical specialists. Most faculty were employed by small, private institutions with faculty sizes ranging from 3 to 29. Only a small percentage of faculty members and program directors did not meet CAPTEs academic credential requirements. However, 26% of the program did not meet CAPTEs requirement for an adequate blend of doctoral degrees. The variables that best distinguished between faculty with high versus low levels of scholarly productivity were type of doctoral degree, academic rank, and years of academic experience. Discussion and Conclusion. When compared with faculty data collected by CAPTE in the preceding decade, todays professoriate shares a similar age range, sex distribution, years of experience, academic rank distribution, and workload percentages as their predecessors. However, the percentage of faculty with doctoral degrees and clinical specialty credentials has increased, and there has been a slight shift in the number employed in small, private institutions. Unfortunately, their level of scholarly productivity has remained stable, and 75% of programs still have one or more faculty members with no scholarly record. Thus, there continues to be a need to recruit more faculty with academic doctorates to replace the large number of retiring senior faculty and to meet the research demands of todays practitioners who are engaged in evidence-based practice.

Educating Students With Disabilities: Are We Doing Enough?

Background and Purpose. The rights of students with disabilities (SWDs) are clearly legislated and align with the core values of the physical therapy profession. However, little is known about the prevalence of SWDs in physical therapist (PT) and physical therapist assistant (PTA) programs, their accommodation needs, and how these accommodations influence didactic and clinical learning experiences. Previous studies have yielded either incomplete or outdated information. Todays physical therapy educators need more accurate information and mechanisms for sharing resources to better anticipate and meet the needs of SWDs in both the classroom and clinical settings. Position and Rationale. We propose 3 initiatives that the physical therapy profession should consider to begin addressing the challenges presented by the matriculation of SWDs into our entry‐level education programs. These initiatives include: (1) mandatory reporting of data on SWDs by all PT and PTA programs as part of the annual accreditation report; (2) development of a uniform list of essential functions/technical standards that all PT and PTA programs could adopt and disseminate to prospective students; and (3) the creation of an electronic database or network for educators to share ideas and resources for accommodating the learning needs of SWDs. Discussion and Conclusions. Over the past 2 decades, physical therapy educators have had intermittent conversations regarding the challenges associated with educating SWDs. We believe that it is time to be more proactive and develop mechanisms for collecting valid data regarding SWDs, standardize the essential functions/technical standards that we expect students to perform, and share ideas and resources for accommodating those students who have a desire to pursue a career in physical therapy, despite the presence of a disability. As a profession that is dedicated to promoting opportunities for people with disabilities, we believe that PT educators can and should provide a successful model for other health professions to follow.