scholarly journals Applying Knowledge Translation Theory to Physical Therapy Research and Practice in Balance and Gait Assessment: Case Report

2015 ◽  
Vol 95 (4) ◽  
pp. 579-587 ◽  
Author(s):  
Kathryn M. Sibley ◽  
Nancy M. Salbach
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Knowledge Translation ◽  
Best Practice ◽  
Physical Therapist ◽  
Intervention Development ◽  
Assessment Tools ◽  
Ongoing Research ◽  
Knowledge To Action ◽  
Gait Assessment

Background and PurposeKnowledge translation (KT) is an emerging discipline with a focus on implementing health evidence in decision making and clinical practice. Knowledge translation theories provide conceptual frameworks that can direct research focused on optimizing best practice. The objective of this case report is to describe one prominent KT theory—the knowledge-to-action (KTA) framework—and how it was applied to research on balance and gait assessment in physical therapist practice.Case DescriptionValid and reliable assessment tools are recommended to evaluate balance and gait function, but gaps in physical therapy practices are known. The KTA framework's 2-pronged approach (knowledge creation phase and action cycle) guided research questions exploring current practices in balance and gait assessment and factors influencing practice in Ontario, Canada, with the goal of developing and evaluating targeted KT interventions.OutcomesResults showed the rate at which therapists use standardized balance and gait tools was less than optimal and identified both knowledge-to-practice gaps and individual and organizational barriers to implementing best assessment practices. These findings highlighted the need for synthesis of evidence to address those gaps prior to the development of potential intervention strategies.DiscussionThe comprehensive KTA framework was useful in guiding the direction of these ongoing research programs. In both cases, the sequence of the individual KTA steps was modified to improve the efficiency of intervention development, there was a need to go back and forth between the 2 phases of the KTA framework, and additional behavior change and barrier assessment theories were consulted. Continued research is needed to explicitly evaluate the efficacy of applying KT theory to best practice in health care.

A Knowledge Translation Framework for Optimizing Physical Therapy in Patients With Heart Failure

2021 ◽  
Author(s):  
Konrad J Dias ◽  
Michael J Shoemaker ◽  
Kristin M Lefebvre ◽  
John D Heick
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Physical Therapy ◽  
Knowledge Translation ◽  
Cardiorespiratory Fitness ◽  
Practice Guideline ◽  
Physical Therapist ◽  
Evidence Based ◽  
Patients With Heart Failure ◽  
The Continuum

Abstract The American Physical Therapy Association (APTA) has supported the development of clinical practice guidelines to promote and support evidence-based practice and reduce unwarranted practice variation. Essential to the success of this effort is the generation of knowledge translation—a concept that emphasizes the translation of global knowledge to an application that can be effectively integrated into clinical practice. The Physical Therapy Clinical Practice Guideline for the Management of Individuals with Heart Failure published in the Physical Therapy Journal in January 2020 provides a broad base of knowledge related to evidence-based treatment interventions for patients with heart failure. However, the application and integration of this knowledge in clinical practice need further elucidation. Therefore, this perspective paper aims to serve as a complementary knowledge translation resource to the recently published practice guideline to maximize the utilization of contemporary evidence in clinical practice. This resource provides the physical therapist with practical guidance in the management of patients with heart failure by placing research findings in the context of other knowledge and practice norms that can be applied at the point of care and across the continuum of care. We propose a novel ABCDE (Assessment, Behavior, Cardiorespiratory Fitness, Dosage, and Education) practical framework. This clinical paradigm is grounded in ongoing physical therapist assessment throughout the episode of care, along with behavior modification, assessment of cardiorespiratory fitness, appropriate selection and dosing of interventions and patient education. Examples highlighting the use of this model in patients with heart failure across the continuum of care are provided for application in clinical care.

scholarly journals Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington

2016 ◽  
Vol 96 (2) ◽  
pp. 252-259 ◽  
Author(s):  
Alan Chong W. Lee ◽  
Michael Billings
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Human Factors ◽  
Clinical Outcomes ◽  
Physical Therapist ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Pilot Program ◽  
Nursing Facility ◽  
Skilled Nursing

Background and Purpose Telehealth is defined as the delivery of health-related services and information via telecommunication technologies. The purposes of this case report are: (1) to describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in an SNF delivered via telehealth. Case Description In 2009, Infinity Rehab conducted a pilot program to determine whether telehealth could be used to meet physical therapist supervision requirements in an SNF. In 2011, language allowing telehealth physical therapy was approved by the Washington Board of Physical Therapy (Board). In 2014–2015, telehealth outcomes were evaluated in a 51-person sample at an Infinity Rehab SNF. Cost savings of telehealth implementation from 2011 to 2015 were estimated. Outcomes The Board deemed the telehealth pilot program a success and subsequently established telehealth practice language for physical therapy. Both human factors and clinical outcomes were required to implement a successful telehealth practice. Clinical outcomes and user satisfaction in telehealth and nontelehealth groups were equivalent. Cost savings were identified. Discussion Human factors, such as the need for provider education in appropriate bedside manner with a telehealth session, were identified. Since 2011, more than 1,000 telehealth physical therapy sessions were conducted at Infinity Rehab SNFs in Washington State. In the future, alternative payment models focused on valued-based clinical outcomes may facilitate wider telehealth adoption in physical therapy. Future research on efficacy and cost-effectiveness is needed to promote broader adoption of telehealth physical therapy in SNFs. This experience demonstrates that telehealth implementation in an SNF for the purpose of physical therapy re-evaluation is a feasible alternative to in-person encounters.

scholarly journals Botulinum Toxin-A use in Paediatric Hypertonia: Canadian Practice Patterns

2012 ◽  
Vol 39 (4) ◽  
pp. 508-515 ◽  
Author(s):  
D. Fehlings ◽  
U. Narayanan ◽  
J. Andersen ◽  
R. Beauchamp ◽  
J. W. Gorter ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Knowledge Translation ◽  
Goal Setting ◽  
Best Practice ◽  
Botulinum Toxin A ◽  
Assessment Tools ◽  
Management Technique ◽  
Toxin A ◽  
Cross Sectional ◽  
Practice Variability

Background:This study aims to assess current practices of Canadian physicians providing botulinum toxin-A (BoNT-A) treatments for children with hypertonia and to contrast these with international “best practice” recommendations, in order to identify practice variability and opportunities for knowledge translation.Methods:Thirteen Canadian physicians assembled to develop and analyze results of a cross-sectional electronic survey, sent to 50 physicians across Canada.Results:Seventy-eight percent (39/50) of physicians completed the survey. The most frequently identified assessment tools were Gross Motor Function Classification System, Modified Tardieu Scale and neurological examination. Goal-setting tools were infrequently utilized. Common indications for BoNT-A injections and the muscles injected were identified. Significant variability was identified in using BoNT-A for hip displacement associated with hypertonia. The most frequent adverse event reported was localized weakness; 54% reporting this “occasionally“ and 15% “frequently”. Generalized weakness, fatigue, ptosis, diplopia, dysphagia, aspiration, respiratory distress, dysphonia and urinary incontinence were reported rarely or never. For dosage, 52% identified 16 Units/kg body weight of Botox® as maximum. A majority (64%) reported a maximum 400 Units for injection at one time. For localization, electrical stimulation and ultrasound were used infrequently (38% and 19% respectively). Distraction was the most frequently used pain-management technique (64%).Conclusions:Canadian physicians generally adhere to international best practices when using BoNT-A to treat paediatric hypertonia. Two knowledge-translation opportunities were identified: use of individualized goal setting prior to BoNT-A and enhancing localization techniques. Physicians reported a good safety profile of BoNT-A in children.

scholarly journals Vestibular Physical Therapy Treatment of Individuals Exposed to Directed Energy

2021 ◽  
Author(s):  
Carrie W Hoppes ◽  
Karen H Lambert ◽  
Brooke N Klatt ◽  
Orlando D Harvard ◽  
Susan L Whitney
Keyword(s):  
Physical Therapy ◽  
Treatment Program ◽  
Best Practice ◽  
Physical Therapist ◽  
Health Condition ◽  
Evidence Based ◽  
Joint Force ◽  
Therapy Regimen ◽  
Published Evidence ◽  
Directed Energy

ABSTRACT Introduction Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. The Joint Force does not have an established protocol to guide vestibular physical therapy for individuals exposed to directed energy. Therefore, we have provided evidence-based guidance for the treatment of oculomotor- and vestibular-related impairments from similar populations. Materials and Methods Published evidence was used to inform suggestions for clinical best practice. We offer resources for the management of non-oculomotor- and non-vestibular-related impairments, before discussing physical therapy interventions for dizziness and imbalance. Results The physical therapist should design a treatment program that addresses the individual’s health condition(s), body structure and function impairments, activity limitations, and participation restrictions after suspected directed energy exposure. This treatment program may include static standing, compliant surface standing, weight shifting, modified center of gravity, gait, and gaze stabilization or vestibular-ocular reflex training. Habituation may also be prescribed. Interventions were selected that require little to no specialized equipment, as such equipment may not be available in all settings (i.e., operational environments). Conclusions Evidence-based guidance for prescribing a comprehensive vestibular physical therapy regimen for individuals exposed to directed energy may aid in their rehabilitation and return to duty. This standardized approach can help physical therapists to treat complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.

scholarly journals Maintaining Mobility in a Patient Who Is Pregnant and Has COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Case Report

2020 ◽  
Vol 101 (1) ◽  
Author(s):  
Alex Mark ◽  
Jennifer P Crumley ◽  
Kristina L Rudolph ◽  
Kevin Doerschug ◽  
Anna Krupp
Keyword(s):  
Infectious Disease ◽  
Case Report ◽  
Physical Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Physical Therapist ◽  
Routine Activity ◽  
Early Mobility ◽  
Membrane Oxygenation ◽  
Novel Approach

Abstract Objective Mobilization while receiving life support interventions, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO), is a recommended intensive care unit (ICU) intervention to maintain physical function. The purpose of this case report is to describe a novel approach to implementing early mobility interventions for a patient who was pregnant and receiving ECMO while continuing necessary infectious disease precautions because of diagnosed coronavirus disease-19 (COVID-19). Methods A 27-year-old woman who was pregnant was admitted to the ICU with COVID-19 and rapidly developed acute respiratory failure requiring 9 days of ECMO support. After a physical therapist consultation, the patient was standing at the bedside by hospital day 5 and ambulating by hospital day 9. Results The patient safely participated in physical therapy during ICU admission and was discharged to home with outpatient physical therapy follow-up after 14 days of hospitalization. Conclusion Early mobility is feasible during ECMO with COVID-19, and active participation in physical therapy, including in-room ambulation, may facilitate discharge to home. Innovative strategies to facilitate routine activity in a patient who is critically ill with COVID-19 require an established and highly trained team with a focus on maintaining function. Impact Early mobility while intubated, on ECMO, and infected with COVID-19 is feasible while adhering to infectious disease precautions when it is performed by an experienced interdisciplinary team.

scholarly journals Determining Current Physical Therapist Management of Hip Fracture in an Acute Care Hospital and Physical Therapists' Rationale for This Management

2011 ◽  
Vol 91 (10) ◽  
pp. 1490-1502 ◽  
Author(s):  
Susie Thomas ◽  
Shylie Mackintosh ◽  
Julie Halbert
Keyword(s):  
Hip Fracture ◽  
Physical Therapy ◽  
Acute Care ◽  
Best Practice ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Acute Care Hospital ◽  
Early Mobilization ◽  
Care Hospital ◽  
Retrospective Case

Background Physical therapy has an important role in hip fracture rehabilitation to address issues of mobility and function, yet current best practice guidelines fail to make recommendations for specific physical therapy interventions beyond the first 24 hours postsurgery. Objectives The aims of this study were: (1) to gain an understanding of current physical therapist practice in an Australian acute care setting and (2) to determine what physical therapists consider to be best practice physical therapist management and their rationale for their assessment and treatment techniques. Design and Methods Three focus group interviews were conducted with physical therapists and physical therapist students, as well as a retrospective case note audit of 51 patients who had undergone surgery for hip fracture. Results Beyond early mobilization and a thorough day 1 postoperative assessment, great variability in what was considered to be best practice management was displayed. Senior physical therapists considered previous clinical experience to be more important than available research evidence, and junior physical therapists modeled their behavior on that of senior physical therapists. The amount of therapy provided to patients during their acute inpatient stay varied considerably, and none of the patients audited were seen on every day of their admission. Conclusions Current physical therapist management in the acute setting for patients following hip fracture varies and is driven by system pressures as opposed to evidence-based practice.

scholarly journals The Use of a Knowledge Translation Program to Increase Use of Standardized Outcome Measures in an Outpatient Pediatric Physical Therapy Clinic: Administrative Case Report

2015 ◽  
Vol 95 (4) ◽  
pp. 613-629 ◽  
Author(s):  
Joseph Schreiber ◽  
Gregory F. Marchetti ◽  
Brook Racicot ◽  
Ellen Kaminski
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Knowledge Translation ◽  
Outcome Measures ◽  
Physical Therapists ◽  
Practice Change ◽  
Knowledge Broker ◽  
Self Report ◽  
Knowledge Assessment ◽  
Frequency Of Use

Background and Purpose Pediatric physical therapists face many challenges related to the application of research evidence to clinical practice. A multicomponent knowledge translation (KT) program may be an effective strategy to support practice change. The purpose of this case report is to describe the use of a KT program to improve the knowledge and frequency of use of standardized outcome measures by pediatric physical therapists practicing in an outpatient clinic. Case Description This program occurred at a pediatric outpatient facility with 1 primary clinic and 3 additional satellite clinics, and a total of 17 physical therapists. The initial underlying problem was inconsistency across staff recommendations for frequency and duration of physical therapist services. Formal and informal discussion with the department administrator and staff identified a need for increased use of standardized outcome measures to inform these decisions. The KT program to address this need spanned 6 months and included identification of barriers, the use of a knowledge broker, multiple workshop and practice sessions, online and hard-copy resources, and ongoing evaluation of the KT program with dissemination of results to staff. Outcome measures included pre- and post-knowledge assessment and self-report surveys and chart review data on use of outcome measures. Outcomes Participants (N=17) gained knowledge and increased the frequency of use of standardized outcome measures based on data from self-report surveys, a knowledge assessment, and chart reviews. Discussion Administrators and others interested in supporting practice change in physical therapy may consider implementing a systematic KT program that includes a knowledge broker, ongoing engagement with staff, and a variety of accessible resources.

scholarly journals Facilitators and Barriers for Using Outcome Measuring Tools in Physical Therapy Practice

2021 ◽  
Vol 15 (6) ◽  
pp. 2126-2129
Author(s):  
Rahat Ayub ◽  
Somia Sabeeh Awan ◽  
Muhamamd Rizwan ◽  
Rabia Majeed ◽  
Rabia Jawa ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Key Words ◽  
Outcome Measures ◽  
Physical Therapist ◽  
Assessment Tools ◽  
The Other ◽  
Study Population ◽  
Facilitators And Barriers ◽  
Study Participants ◽  
E Mail

Objective: The study was conducted toascertain the percentage of physiotherapist who were utilizing the outcome measures during the treatment of patients and to find the factors which were potentiating the physiotherapists in implementing the outcome measuring tools in the treatment of their patients. On the other hand, such factors were also looked into which were considered as obstacles by the physiotherapists in the use of the tools. Methodology: The estimated study population size was 242. Data was collected through e-mail as well as through one-on-one meeting with the physiotherapists by using a standard questionnaire (appendix I) and was analyzed through SPSS version 20. Results: It was found that 78 percent of the study participants were using the outcome measures in the assessments of the patients and for finding the progression in their condition. The feeling of the patient about the keen involvement of the physiotherapist in his treatment, enhanced communication between two of them and increased efficiency of examination were the major facilitators which urged the physiotherapists to use outcome measures in their practice. The most frequent barriers seen were the duration required by physiotherapist to analyze the score and duration of patient to complete it. Conclusion: The main facilitators are increased communication between physiotherapist and patient and enhanced the efficacy of assessment. Alternatively, the main barriers restricting the usage of outcome measures are reported to be the inability to complete the various assessment tools due to the lack of time on the part of the patient as well as the physical therapist. Key words: Outcome measures, Outcomes measuring tools, Facilitators, Barriers, Physical therapist, Physiotherapist

Utilization of Safe Fall Landing Strategies in Physical Therapist Management of Geriatric Populations: A Case Report

2020 ◽  
Author(s):  
S G Kinney ◽  
J D Kiesel
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Physical Therapist ◽  
Standing Position ◽  
Patient Specific ◽  
Future Research ◽  
Practice Setting ◽  
Geriatric Population ◽  
Therapy Program ◽  
Initial Score

Abstract Objective Safe fall landing strategies (SFLS) have shown promise to decrease injury during falls but have been examined primarily in young, healthy populations. There is emerging evidence to suggest SFLS can be safe and effective for a geriatric population; however, this intervention has not been examined in a clinical physical therapist practice setting. This case study seeks to determine how SFLS can be incorporated into a physical therapy program with a geriatric population. Methods (Case Description) A 77-year-old woman reported imbalance and inability to return to her previous active lifestyle. Multiple SFLS were implemented during the course of physical therapist management. Controlled fall heights were gradually progressed over the course of therapy. Outcomes Gains in Patient Specific Functional Scale score (initial score = 2.5, discharge score = 8), static balance, and ability to perform floor-to-waist lifting were seen following physical therapist intervention that included SFLS. The patient was able to perform a back fall and a front fall from a standing position and reported no adverse side effects throughout the course of physical therapy care. Discussion This case report demonstrates how SFLS were safely and pragmatically progressed for one patient in a clinical physical therapy setting. SFLS may have the potential to improve patient outcomes and even decrease the risks associated with falls, though further evaluation is needed. Impact This case report introduces SFLS as an emerging intervention in the clinical physical therapist practice setting. This case report should encourage future research needed to assess the effectiveness and safety of this treatment strategy in physical therapy.

scholarly journals Physical Therapy Management of an Individual With Post-COVID Syndrome: A Case Report

2021 ◽  
Author(s):  
Kirby P Mayer ◽  
Angela K Steele ◽  
Melissa K Soper ◽  
Jill D Branton ◽  
Megan L Lusby ◽  
...  
Keyword(s):  
Case Report ◽  
Cognitive Function ◽  
Physical Therapy ◽  
Muscle Strength ◽  
Exercise Capacity ◽  
Cognitive Dysfunction ◽  
Clinical Presentation ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Emotional Health

Abstract Objective The purpose of this case report is to present the clinical presentation and physical therapist management for a patient with post–COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post–COVID syndrome. Methods (Case Description) A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms including dyspnea, headaches, and cognitive fog. On day 62, she participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of her age-predicted 6-minute walk distance (6MWD). She had minor reductions in muscle strength and cognitive function. Self-reported quality of life (QoL) was 50, and she scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD). Results The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task (METS) levels increased with variability over the course of the program. The patient’s muscle strength, physical function, and exercise capacity improved. 6MWD increased by 199 m, equating to 80% of her age-predicted distance. QoL and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction. Conclusion This case report described the clinical presentation and physical therapist management of a person with post–COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post–COVID syndromes. Impact This case alerts physical therapists to post–COVID syndrome—which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction—and to the role that therapists can play in assessing these symptoms and managing these patients.

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