scholarly journals Physical Therapist Practice in the Intensive Care Unit: Results of a National Survey

2015 ◽  
Vol 95 (10) ◽  
pp. 1335-1344 ◽  
Author(s):  
Daniel Malone ◽  
Kyle Ridgeway ◽  
Amy Nordon-Craft ◽  
Parker Moss ◽  
Margaret Schenkman ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Physical Therapy ◽  
Acute Care ◽  
National Survey ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Community Hospitals ◽  
American Physical

Background Early rehabilitation improves outcomes, and increased use of physical therapist services in the intensive care unit (ICU) has been recommended. Little is known about the implementation of early rehabilitation programs or physical therapists' preparation and perceptions of care in the United States. Objective A national survey was conducted to determine the current status of physical therapist practice in the ICU. Design This study used a cross-sectional, observational design. Methods Self-report surveys were mailed to members of the Acute Care Section of the American Physical Therapy Association. Questions addressed staffing, training, barriers, and protocols, and case scenarios were used to determine perceptions about providing rehabilitation. Results The response rate was 29% (667/2,320). Staffing, defined as the number of physical therapists per 100 ICU beds, was highest in community hospitals (academic: median=5.4 [range=3.6–9.2]; community: median=6.7 [range=4.4–10.0]) and in the western United States (median=7.5 [range=4.2–12.9]). Twelve percent of physical therapists reported no training. Barriers to providing ICU rehabilitation included insufficient staffing and training, departmental prioritization policies, and inadequate consultation criteria. Responses to case scenarios demonstrated differences in the likelihood of consultation and physical therapists' prescribed frequency and intensity of care based on medical interventions rather than characteristics of patients. Physical therapists in academic hospitals were more likely to be involved in the care of patients in each scenario and were more likely to perform higher-intensity mobilization. Limitations Members of the Acute Care Section of the American Physical Therapy Association may not represent most practicing physical therapists, and the 29% return rate may have contributed to response bias. Conclusions Although staffing was higher in community hospitals, therapists in academic and community hospitals cited insufficient staffing as the most common barrier to providing rehabilitation in the ICU. Implementing strategies to overcome barriers identified in this study may improve the delivery of ICU rehabilitation services.

scholarly journals Decision-Making Ability of Physical Therapists: Physical Therapy Intervention or Medical Referral

2006 ◽  
Vol 86 (12) ◽  
pp. 1619-1629 ◽  
Author(s):  
Diane U Jette ◽  
Kerry Ardleigh ◽  
Kellie Chandler ◽  
Lesley McShea
Keyword(s):  
Physical Therapy ◽  
Confidence Interval ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Direct Access ◽  
Medical Conditions ◽  
Musculoskeletal Conditions ◽  
Logistic Regressions ◽  
American Physical ◽  
Medical Referral

Abstract Background and PurposeOpponents of direct access to physical therapy argue that physical therapists may overlook serious medical conditions. More information is needed to determine the ability of physical therapists to practice safely in direct-access environments. The purpose of this study was to describe the ability of physical therapists to make decisions about the management of patients in a direct-access environment. Subjects. Of a random sample of 1,000 members of the Private Practice Section of the American Physical Therapy Association, 394 participated. Methods. A survey included 12 hypothetical case scenarios. For each case, participants determined whether they would provide intervention without referral, provide intervention and refer, or refer before intervention. The percentage of correct decisions for each group of scenarios was calculated for each participant, and participants were classified as having made correct decisions for 100% of cases or less for each group. Three sets of logistic regressions were completed to determine the characteristics of the participants in relation to the decision category. Results. The average percentages of correct decisions were 87%, 88%, and 79% for musculoskeletal, noncritical medical, and critical medical conditions, respectively. Of all participants, approximately 50% made correct decisions for all cases within each group. The odds of making 100% correct decisions if a physical therapist had an orthopedic specialization were 2.23 (95% confidence interval=1.35–3.71) for musculoskeletal conditions and 1.89 (95% confidence interval=1.14–3.15) for critical medical conditions. Discussion and Conclusion. Physical therapists with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions.

scholarly journals Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series

2020 ◽  
Author(s):  
Sabrina Eggmann ◽  
Angela Kindler ◽  
Andrea Perren ◽  
Natalie Ott ◽  
Frauke Johannes ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Critically Ill ◽  
Acute Care ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Treatment Strategies ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Potential Treatment ◽  
Prone Positioning

Abstract Objective The aim of this case series was to describe the experience of Swiss physical therapists in the treatment of patients with COVID-19 during their acute care hospital stay and to discuss challenges and potential strategies in the clinical management of these patients. Methods We report 11 cases of patients with COVID-19 from five Swiss hospitals that illustrate the various indications for physical therapy, clinical challenges, potential treatment methods and short-term response to treatment. Results Physical therapists actively treated patients with COVID-19 on wards and in the ICU. Interventions ranged from patient education, to prone positioning, to early mobilization and respiratory therapy. Patients were often unstable with quick exacerbation of symptoms and a slow and fluctuant recovery. Additionally, many patients who are critically ill developed severe weakness, post-extubation dysphagia, weaning failure or presented with anxiety or delirium. In this setting, physical therapy was challenging and required specialized and individualized therapeutic strategies. Most patients adopted the proposed treatment strategies and lung function and physical strength improved over time. Conclusion Physical therapists clearly have a role in the COVID-19 pandemic. Based on our experience in Switzerland, we recommend that physical therapists routinely screen and assess patients for respiratory symptoms and exercise tolerance on acute wards. Treatment of patients who are critically ill should start as soon as possible to limit further sequelae. More research is needed for awake prone positioning, early breathing exercises as well as post-COVID rehabilitation. Impact To date there are few data on the physical therapist management of patients with COVID-19. This article is among the first to describe the role of physical therapists in the complex pandemic environment and to describe the potential treatment strategies for countering the various challenges in the treatment of these patients.

scholarly journals Physical Therapist Treatment of Patients in the Neurological Intensive Care Unit: Description of Practice

2015 ◽  
Vol 95 (7) ◽  
pp. 1006-1014 ◽  
Author(s):  
Peter D. Sottile ◽  
Amy Nordon-Craft ◽  
Daniel Malone ◽  
Darcie M. Luby ◽  
Margaret Schenkman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Physical Therapy ◽  
Physical Therapist ◽  
Icp Monitoring ◽  
Neurological Intensive Care Unit ◽  
Neurological Intensive Care ◽  
Physical Therapy Session ◽  
Therapy Sessions

Background Although studies have established the safety and feasibility of physical therapy in the critical care setting, minimal information about physical therapist practice in the neurological intensive care unit (NICU) is available. Objective This study describes physical therapists' treatment of people admitted to a NICU. Design People admitted to the NICU with a diagnosis of subarachnoid hemorrhage, subdural hematoma, intracranial hemorrhage, or trauma were retrospectively studied. Methods Data on patient demographics, use of mechanical ventilation, and intracranial pressure (ICP) monitoring were collected. For each physical therapy session, the length of the session, the location (NICU or post-NICU setting), and the presence of mechanical ventilation or ICP monitoring were recorded. Data on safety parameters, including vital sign response, falls, and dislodgement of lines, were collected. Results Over 1 year, 180 people were admitted to the NICU; 86 were evaluated by a physical therapist, for a total of 293 physical therapy sessions in the NICU (n=132) or post-NICU setting (n=161). Only one session (0.3%) was stopped, secondary to an increase in ICP. The first physical therapy session occurred on NICU day 3.0 (25%–75% interquartile range=2.0–6.0). Patients received a median of 3.4 sessions per week (25%–75% interquartile range=1.8–5.9). Patients with mechanical ventilation received less frequent physical therapy sessions than those without mechanical ventilation. Patients with ICP monitoring received less frequent sessions than those without ICP monitoring. However, after multivariate analysis, only the admission Glasgow Coma Score was independently associated with physical therapy frequency in the NICU. Patients were more likely to stand, transfer, and walk in the post-NICU setting than in the NICU. Limitations The results are limited by the retrospective, single-center nature of the study. There is inherent bias of evaluating only those patients who had physical therapy, and therapists were unable to completely adjust for the severity of illness of a given patient. Conclusions Physical therapy was performed safely in the NICU. Patients who required invasive support received less frequent physical therapy.

The Use of Yoga by Physical Therapists in the United States

2017 ◽  
Vol 27 (1) ◽  
pp. 69-79 ◽  
Author(s):  
Mary E. Wims ◽  
Shayla M. McIntyre ◽  
Ann York ◽  
Laura G. Covill
Keyword(s):  
United States ◽  
Physical Therapy ◽  
Physical Therapists ◽  
The United States ◽  
Primary Concern ◽  
Health And Wellness ◽  
Clinical Practices ◽  
Post Discharge ◽  
Electronic Communications ◽  
American Physical

Abstract How physical therapists (PTs) in the United States currently use yoga in their clinical practices is unknown. The purpose of this study was to determine how PTs in the United States view yoga as a physical therapy (PT) tool and how PTs use yoga therapeutically. The authors conducted a 24-item survey via electronic communications of the Geriatric, Orthopedic, Pediatric, and Women's Health Sections of the American Physical Therapy Association. Participants (n = 333) from 47 states and the District of Columbia replied. Reported use of therapeutic yoga among participants was high (70.6%). Of those participants, nearly a third use asana and pranayama only. Most participants using therapeutic yoga also include additional mindfulness-related elements such as sensory awareness, concentration/focus, and/or meditation. Most participants learned about yoga through personal experiences, with many participants citing lack of familiarity in using yoga in PT practice. Safety is the primary concern of participants when recommending yoga to patients as an independent health and wellness activity. Interdisciplinary communication between PTs, yoga therapists, and yoga teachers is warranted to address the post-discharge needs of clients. Healthcare changes have required PTs to adapt to a biopsychosocial-spiritual model (BPSS) for improved patient outcomes. Therapeutic yoga may provide an opportunity for PTs to expand their role in health and wellness and chronic disease management. There is opportunity for continuing education in therapeutic yoga for PTs.

Administration and Management Skills Needed by Physical Therapist Graduates in 2010: A National Survey

2007 ◽  
Vol 87 (3) ◽  
pp. 261-281 ◽  
Author(s):  
D Sue Schafer ◽  
Rosalie B Lopopolo ◽  
Kathleen A Luedtke-Hoffmann
Keyword(s):  
Physical Therapy ◽  
Skill Acquisition ◽  
Financial Analysis ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Management Skills ◽  
Health Care Environment ◽  
Doctor Of Physical Therapy ◽  
Skill Groups ◽  
American Physical

Background and Purpose Administration and management (A&M) skills are essential to physical therapist practice. This study identified which A&M skills will be most critical for future Doctor of Physical Therapy (DPT) graduates to possess upon entry into clinical practice. Subjects and Methods Using a 7-point scale, 435 randomly selected American Physical Therapy Association members (physical therapists) rated 121 A&M skills based on expectation of the level of independence required by a new DPT graduate. Results No differences among respondents based on role, work setting, or experience were found, so the data were combined for factor analyses, producing 16 A&M skill groups. The most independence was expected in skills related to self-management, compliance with rules, ethical behavior, and insurance coding. Skills requiring the most assistance were marketing and strategic planning, financial analysis and budgeting, and environmental assessment. Discussion and Conclusion This study has identified the level of independence for the A&M skills needed by new DPT graduates, provided empirical evidence suggesting which A&M skills should be included in DPT curricula, and suggested a pattern of A&M skill acquisition that applies first to the new therapist and the patient, then to the organization, and finally to the health care environment.

scholarly journals What Follows Survival of Critical Illness? Physical Therapists' Management of Patients With Post–Intensive Care Syndrome

2013 ◽  
Vol 93 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Anita R. Bemis-Dougherty ◽  
James M. Smith
Keyword(s):  
Intensive Care ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Task Force ◽  
Early Mobilization ◽  
Long Term Outcomes ◽  
Icu Discharge ◽  
Long Term Follow Up ◽  
American Physical

Historically, the management of patients in the intensive care unit (ICU) has involved immobilization and sedation, with care focused on physiological impairments and survival. Because more ICU patients are now surviving their hospital stay, it is imperative that their ICU care be managed with the goal of long-term health, wellness, and functioning. The evidence confirms that mobilization and exercise are feasible in the ICU and demonstrates that the benefits of early mobilization include reduced length of stay in the ICU and hospital. In 2010, the Society of Critical Care Medicine (SCCM) invited key stakeholder groups, including the American Physical Therapy Association (APTA), to identify strategies to improve long-term consequences following ICU discharge, including early mobilization in the ICU and integration of the physical therapist as a member of the ICU team. This model appears to be successful in some institutions, but there is variation among institutions. The SCCM Task Force developed major areas of focus that require multidisciplinary action to improve long-term outcomes after discharge from an ICU. This article describes physical therapist practice in the management of ICU survivors, the importance of long-term follow-up after ICU discharge, and how APTA is taking steps to address the major areas of focus identified by the SCCM Task Force to improve long-term outcomes after ICU discharge.

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.

Referral for Imaging in Physical Therapist Practice: Key Recommendations for Successful Implementation

2021 ◽  
Author(s):  
Aaron Paul Keil ◽  
Charles Hazle ◽  
Amma Maurer ◽  
Connie Kittleson ◽  
Daniel Watson ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Diagnostic Imaging ◽  
Physical Therapists ◽  
Physical Therapist ◽  
The United States ◽  
Successful Implementation ◽  
Program Accreditation ◽  
Therapy Program ◽  
Normative Practice ◽  
American Physical

Abstract In recent years, the use of diagnostic imaging in physical therapist practice in the United States (US) has gained considerable interest. In several countries around the world and in the US military, patient direct referral for diagnostic imaging has been considered normative practice for decades. US physical therapy program accreditation standards now stipulate that diagnostic imaging content must be included in physical therapist educational curricula. The American Physical Therapy Association (APTA) has made efforts to pursue practice authority for imaging referral. A recent review of state practice acts and other statutory language concluded that many states have no prohibitions against physical therapists referring for imaging studies. Additionally, physical therapists can now pursue certification as musculoskeletal sonographers. In light of these advances, and with a growing number of PTs serving patients who have not yet seen another healthcare provider, it may be helpful for those who have been actively involved in the use of imaging in PT practice to provide their collective recommendations to serve as a guideline to those interested in incorporating this practice privilege. The purpose of this perspective article is to provide an overview of the key elements necessary for effective implementation of referral for imaging in physical therapist practice while emphasizing the cornerstone of effective communication.

Guide to Physical Therapist Practice

1997 ◽  
Vol 77 (11) ◽  
pp. 1163-1650 ◽  
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Professional Education ◽  
Health Care Services ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Daily Practice ◽  
Care Services ◽  
Provision Of Services ◽  
American Physical

Preface All health care professions are accountable to the various publics that they serve. The American Physical Therapy Association (APTA) has developed Guide to Physical Therapist Practice (“the Guide”) to help physical therapists analyze their patient/client management and describe the scope of their practice. The Guide is necessary not only to daily practice but to preparation of students. It was used as a primary resource by the Commission on Accreditation in Physical Therapy Education (CAPTE) during its revision of evaluative criteria for physical therapist professional education programs and is an essential companion document to The Normative Model of Physical Therapist Professional Education, Version 97. Specifically, the Guide is designed to help physical therapists (1) enhance quality of care, (2) improve patient/client satisfaction, (3) promote appropriate utilization of health care services, (4) increase efficiency and reduce unwarranted variation in the provision of services, and (5) promote cost reduction through prevention and wellness initiatives. The Guide also provides a framework for physical therapist clinicians and researchers as they refine outcomes data collection and analysis and develop questions for clinical research.

“Choose Physical Therapy” for Neonatal Abstinence Syndrome: Clinical Management for Infants Affected by the Opioid Crisis

2019 ◽  
Vol 99 (6) ◽  
pp. 771-785 ◽  
Author(s):  
Dana B McCarty ◽  
Jennifer R Peat ◽  
Shannon O'Donnell ◽  
Elisabeth Graham ◽  
William F Malcolm
Keyword(s):  
Physical Therapy ◽  
Parent Education ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Safe Alternative ◽  
Pharmacological Management ◽  
Opioid Crisis ◽  
American Physical

Abstract In response to the opioid crisis, the American Physical Therapy Association has strongly advocated for physical therapy as a safe alternative to pharmacological pain management through the “#ChoosePT” campaign and the dedication of a PTJ special issue to the nonpharmacological management of pain. Physical therapists not only play an important role in the rehabilitation of the nearly 2 million adolescents and adults addicted to prescription opioids but also provide care to infants born to mothers with various drug addictions. This Perspective article explores the incidence, pathophysiology, and risk factors for neonatal abstinence syndrome and describes the clinical presentations of withdrawal and neurotoxicity in infants. Discipline-specific recommendations for the physical therapist examination and plan of care, including pharmacological management considerations, are outlined. Nonpharmacological management, including supportive care, feeding, parent education, social aspects of care, and follow-up services, are discussed from a physical therapy perspective. Finally, this article reviews developmental outcomes in infants with neonatal abstinence syndrome and reflects on challenges and future directions of research in this area.

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