Susan G Klappa

Promoting Community Health and Eliminating Health Disparities Through Community-Based Participatory Research

In physical therapy, there is increasing focus on the need at the community level to promote health, eliminate disparities in health status, and ameliorate risk factors among underserved minorities. Community-based participatory research (CBPR) is the most promising paradigm for pursuing these goals. Community-based participatory research stresses equitable partnering of the community and investigators in light of local social, structural, and cultural elements. Throughout the research process, the CBPR model emphasizes coalition and team building that joins partners with diverse skills/expertise, knowledge, and sensitivities. This article presents core concepts and principles of CBPR and the rationale for its application in the management of health issues at the community level. Community-based participatory research is now commonly used to address public health issues. A literature review identified limited reports of its use in physical therapy research and services. A published study is used to illustrate features of CBPR for physical therapy. The purpose of this article is to promote an understanding of how physical therapists could use CBPR as a promising way to advance the professions goals of community health and elimination of health care disparities, and social responsibility. Funding opportunities for the support of CBPR are noted.

Professionalism Unveiled in DPT Student Monologues

Purpose/Hypothesis: Doctor of Physical Therapy (DPT) students who reflect on personal beliefs and perform monologues in a capstone course were able to articulate strategies for advocacy and catalyzing change. Number of subjects: 40 DPT Students completed a questionnaire and participated in a focus group after performing monologue talks. Community members (n=20) in attendance at the monologue performances completed a questionnaire about lessons learned from the students. Materials and methods: This phenomenological study investigated DPT students (n=40) in a capstone course who performed Student TED (STED) talk monologues on the topic of becoming a new professional. Phenomenological methods were used to answer the following research questions: 1) How do experiences in life shape DPT student beliefs as an emerging entry-level physical therapist? 2) What do DPT students believe about their role as a new professional after performing a STED monologue talk? 3) What did the community learn about physical therapy after attending the STED monologue talks? Results: Students were shaped by personal experiences in their lives as they began transitioning identity into entrylevel physical therapists. Roles of an advocate were embraced. Students positively viewed their role in transforming society and catalyzing change through social responsibility. Community members gained a deeper understanding of what the physical therapy profession offers society. Conclusions: Beliefs of DPT students regarding the physical therapy profession were shaped by lived experiences as student transitioned to entry-level physical therapists. Students embraced advocacy as a professional duty. The community gained a deeper understanding of physical therapy. Clinical relevance: Unveiling professional identity requires reflection and an opportunity to embody professional roles beyond clinic walls. Opportunities to engage in public discourse should be encouraged in the curriculum.

Compassion satisfaction- Taking care of our physios means better patient care

Relevance: OA knee is one of the most common conditions leading functional disabilities seen worldwide. There are different methods to manage osteoarthritis, conservatively, and/or surgically. Physiotherapy treatment, as a part of conservative management, involves reduction of pain, improvement of muscle strength and improvement of functional ability by various approaches like exercise therapy, electrotherapy and manual therapy techniques. Quadriceps muscle weakness is one of the main features seen in OA knee. Russian current stimulation has been successfully used to increase muscle strength in healthy athletes but its effect on quadriceps muscle strength in OA knee has not been studied. Hence the present study was undertaken to know the effect of Russian current stimulation on quadriceps muscle strength in patients with primary OA knee. Participants: 30 subjects (mean age 50.25±6.35 years) diagnosed with primary OA knee were recruited from Out-Patient Department of Physiotherapy of KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Method: Subjects were randomly allocated into 2 groups namely Group A (n=15) who received Short Wave Diathermy (SWD) and exercises and Group B (n=15) who received SWD, exercises and Russian current stimulation for 10 days. The outcome measures were Visual Analog Scale (VAS) for pain, muscle strength by using Handheld dynamometer, and WOMAC osteoarthritis index for functional disability. Analysis: Within group and between group analysis after intervention was done to assess changes using paired t-test and unpaired t - tests. Result: The VAS scores for group A reduced from 6.8±1.49 (baseline) to1.4±0.91 (post-intervention) and for group B from 6.3±1.29 (baseline) to 1±1.14 (post-intervention). The WOMAC score of group A decreased from 59.7±11.56 (baseline) to 24.1±6.01 (post-intervention) and of group B decreased from 50.4±22.30 (baseline) to 12.5±7.54 (post-intervention). The muscle strength of group A increased from 7.9±0.94 (baseline) to 8.6±0.95 (post-intervention) and of group B it increased from 8.3±0.67 (baseline) to 10.6±0.89 (post-intervention).Group B showed better improvement in muscle strength and function than group A. The intra group and between group comparison was statistically significant with p= <0.001 for both the groups. Conclusion: Russian current stimulation is effective in increasing quadriceps muscle strength and secondarily improving the functional ability in subjects with primary OA knee.Results: Weaning success was present in 76.5% and weaning failure in 17.5% of patients. There were 6% of reintubations. The predictive power for RR weaning failure, RR best cut-off point > 24 breaths per minute (bpm), was: Sensitivity 100%, specificity 85%, and accuracy 88% (ROC curve, p 24 bpm). There were 15% false positives, weaning successes with RR>24 bpm.Introduction: Internet is one of the fastest growing media for Human Resources and Development (HRD). Computer has become an essential part of our Activities of Daily Livings (ADLs) at one hand and other hand, prolonged computer usage has increases the risk of occupational hazards. Prolonged Static work at computer system is a causative factor for poor postural ergonomic, structural derangements and dysfunction commonly at neck, shoulder and low back structures to develop functional limitation and progressively functional disabilities. The basic health education (HE) by means of ergonomic advises and exercise therapy may have efficacy to promote, prevent and cure for such FDs. However, internet itself can be a mode of HE system to be provided at workplace to cut the time & cost together. Purpose of Study: To find the efficacy of IBM for FDs of the computer users. Materials: Internet supported computer, web-site (www.ptmovements.com), web pages, basic health assessment form, Self Reported FD Questioners, Neck Disability Index (NDI) & Back Pain Functional Scale (BPFS), Study Design: Experimental Clinical Trial Methodology: 1256 computer users (M=867) participated online and assess for inclusive & exclusive criterions. Internet based self reported FDs questioners used to assess FDs in prior and post to two weeks of tailor made treatment program. Data Analysis: significance of FDs and impact of IBM on FDs was analyzed with SPSS -17, LOS set at 0.05 or CI 95 % Result: mild to moderate prevalence of FDs was higher neck & shoulder as compared to low back structures. The IBM has shown efficiency to reduce the level of FDs at NDI, and BPFS. Discussion: The internet based health education (IBHE) is well possible to deliver and to reduce the FDs. The advantage of time & cost effective approach in IBM has facilitated keen interest among computer users. Conclusion: The IBHE is well efficient and prospective to develop scopes of “workplace wellness” to promote, prevents, and cures for occupational diseases & disorders. E-health education has great prospectus in field of modern medicine. [ Rathod P et al NJIRM 2011; 2(4) : 77-82]T presentation is to understand comprehensive postural compensation patterns based on kinetic data on the ground as well as kinematic data from trunk motion to assess balance. Firstly, positional-dependent spinal loading with trunk motion is important to relate with center of pressure from the ground for effective rehabilitation intervention and strategies. The combined kinetic and kinematic measurements lead to a better understanding of spinal movement patterns to clarify the relationship between kinematic and kinetic changes in subjects with recurrent LBP. The first part of my presentation is to provide assessment tools for normalized kinematic and kinetic stability indices while considering visual input during one leg standing. Secondly, the shoulder and pelvis kinematics will be compared based on range of motion (ROM), angular velocity, and relative phase (RP) values during trunk axial rotation. The results of this study will be included the difference in should and pelvic girdle motion in the transverse plane during axial trunk rotation. This pattern of trunk movement could be due to possible pelvic stiffness with neuromuscular constraints. Since subjects with recurrent LBP demonstrated decreased pelvic rotation compared to the shoulder for postural control, increased pelvic flexibility could enhance coordinated movement patterns in order to integrate spinal motion.A commonly disrupts the balance control and compensatory postural responses that contribute to maintaining balance and preventing falls during perturbation of posture due to the weakness of lower limb muscles. For prevention of fall, certain fall prevention programs has to be given to the patients which will mainly focus on the stimulation of primary muscle groups of lower limb that will help in activating the normal balance strategies. The purpose of the study was to establish the effect of PBBT (Perturbation Based Balance Training) added to strengthening and balance exercises in improving balance and to reduce falls among older adults. Forty elderly patients aged 65 to 80 years were randomized in two groups by using block randomization. To the group 1 treatment given was standardized OET which is a set of leg muscle strengthening and balance retraining exercises designed specifically to prevent falls. Group 2 was given PBBT along with OET (Otago Exercise Training). Outcome variables measured on force plate are maximum Center of pressure excursion, minimum Center of pressure excursion and stability score. Other then force plate variables the outcome measure taken was TUG (Timed Up & Go Test). The results were checked after two months. Treatment effect was checked within the group by using paired t test and between the groups by using unpaired t test. The results showed significant difference in values of maximum Center of pressure excursion, minimum Center of pressure excursion and stability score in all the four conditions which are NS EO (Normal Stability Eyes Open), NS EC (Normal Stability Eyes Closed), PS EO (Perturbation Stability Eyes Open) & PS EC (Perturbation Stability Eyes closed) within the group. There was also a significant reduction in the values of TUG. Between groups analysis also show significant effect between both the groups. Findings of this study showed better results in the patients belong to group 2 which were given PBBT along with OET. The PBBT is a useful program for fall prevention. It is also inexpensive and compact commercial perturbation-delivery system which would promote widespread clinical application.