RESUMEN

OBJECTIVE: This exploratory study examined the prevalence and determinants of the use of the title 'doctor' among the United States (U.S.) licensed Doctors of Physical Therapy (DPTs) during patient-provider introductions. METHODS: A cross-sectional analysis of DPTs across eight states was conducted. Binary logistic regression analyzed demographic and experience-related factors influencing title use, including years of experience, board certification status, and clinical instructor (CI) experience. Stepwise logistic regression with forward selection identified significant predictors. Beliefs influencing title use were evaluated through descriptive statistics from multiple choice questions with an option for open-ended responses for additional opinions. RESULTS: Of the 1,311 participants who met the inclusion criteria, 19.9% reported using 'doctor' during patient-provider introductions. The odds of using the title increased with age and was higher among males, with age controlled for. Completion of a residency program and not being a CI were also associated with greater odds of title use, with age and sex controlled for. Beliefs about demonstrating expertise, having earned the title, and advancing the profession were primary reasons for using the title, while concerns about patient confusion and therapeutic alliance were reasons for not using it. Both DPTs who did and did not report using the title 'doctor' commonly cited the impact on therapeutic alliance as justification. CONCLUSIONS: A minority of our sample of U.S. DPTs use the title 'doctor' during patient-provider introductions, with significant variation across age, gender, and professional experience. Deciding whether to use the title was primarily based on their perceived effects on patient beliefs. DISCUSSION: This is the first study to formally investigate how DPTs refer to themselves during patient-provider introductions. Understanding title use in healthcare can inform best practices during patient interactions. This study provides a foundation for future research on the impact of DPTs mentioning their doctoral title on patient experiences and outcomes.

RESUMEN

OBJECTIVES: To examine physical therapist awareness and utilization of imaging referral privileges in the United States (US) and how it relates to direct access frequency. METHODS: This study utilized survey data collected in 2020-2021 from US physical therapists. Subjects were asked about imaging referral jurisdictional authority in their state. Responses were analyzed for accuracy and compared to the level of jurisdictional authority and its impact on imaging referral. Analysis of imaging skills performance and imaging referral practices were compared to direct access frequency. RESULTS: Only 42.0% of physical therapists practicing in states that allow imaging referral were aware of this privilege. Those practicing where imaging referral was allowed via state legislation were significantly more likely (p < 0.01) to be aware of this privilege (71.4%) compared to those granted by the state board (25.2%). Those aware of their imaging referral scope were more likely (p < 0.01) to practice imaging referral (44.5%) compared to those who were unaware (3.2%). Direct access frequency was positively associated with imaging skill performance and imaging referral practice (p < 0.01). Doctors of Physical Therapy, residency/fellowship-trained physical therapists, and board-certified physical therapists all reported practicing greater frequency of direct access (p < 0.01). DISCUSSION/CONCLUSION: There is a striking lack of awareness of imaging privileges among physical therapists as influenced by the level of jurisdictional scope. These results suggest that the lack of awareness may have a dampening effect on diagnostic imaging referrals. The American Physical Therapy Association should consider engaging with state boards to raise imaging privilege awareness.

Asunto(s)

RESUMEN

PURPOSE: To analyze the ability of pre-matriculation metrics to predict difficulties during the first year of a Doctor of Physical Therapy (DPT) program with a pass-fail grading system. METHODS: Undergraduate cumulative, science, and pre-requisite grade point averages (GPAs) and verbal and quantitative Graduate Record Examination (GRE) percentiles were collected during the admissions process of 190 students in an accredited DPT program at a southeastern US private university between 2019-2021. Students were dichotomized to groups with and without academic difficulties in coursework and a first-year comprehensive assessment (CA). Independent t-tests identified differences between groups, and logistic regression analyses identified predictors of academic difficulties. Receiver operating characteristic (ROC) curve analyses were performed to identify cut-off scores and risk ratios were calculated. RESULTS: Students with coursework difficulties had lower verbal (d=0.36, p=0.009) and quantitative (d=0.31, p=0.02) GRE scores. Verbal GRE scores were also lower in students who failed the CA (p=0.049). Students who scored less than the 47th percentile on the verbal GRE were 53% more likely to have academic difficulties and 4.2 times more likely to fail the CA than those who scored in the 70th percentile or higher. CONCLUSION: Verbal GRE percentile best predicted academic difficulty in the first year of a DPT program.

Asunto(s)

RESUMEN

OBJECTIVES: To explore if physical therapists are practicing skills necessary to refer patients for musculoskeletal imaging. METHODS: An expert panel established a list of nine requisite skills to refer for musculoskeletal imaging. A blinded expert panel validated the list using a 5-point Likert scale. The skills list was examined via an electronic survey distributed to United States physical therapists. RESULTS: 4,796 respondents were included. Each of the nine skills were routinely performed by a majority of the respondents (range: 54.52-94.72%). Respondents routinely performed 6.95 (± 0.06) skills, with 67.41% routinely performing seven or more skills. Doctors of physical therapy routinely performed more imaging skills (7.15 ± 0.06) compared to their masters- (6.44 ± 0.19) and bachelors-trained (5.95 ± 0.21) counterparts (p < 0.001). Residency/fellowship-trained physical therapists were more likely to routinely perform more imaging skills (7.60 ± 0.11 vs. 6.79 ± 0.07, p < 0.001). Imaging skill performance was greater among board-certified physical therapists (7.39 ± 0.09 vs. 6.71 ± 0.08, p < 0.001) and APTA members (7.06 ± 0.07 vs. 6.65 ± 0.12, p < 0.001). CONCLUSION: Physical therapists are routinely practicing the requisite imaging skills to directly refer to a radiologist for musculoskeletal imaging.

Asunto(s)

RESUMEN

BACKGROUND: Isolated medial cuneiform fracture is a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptoms. An understanding of clinical presentation is needed to expedite diagnosis, facilitate decision making, and guide treatment approach. METHODS: Case studies/series were searched in four databases until September 2019. Included studies had participants with a history of traumatic closed medial cuneiform fracture. Studies were excluded if the medial cuneiform fractures were open fractures, associated with multitrauma, or associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies, and a qualitative synthesis was performed. RESULTS: Ten studies comprising 15 patients were identified. Mean ± SD patient age was 38.0 ± 12.8 years, with 86.7% of reported participants being men. The overall methodological quality was moderate to high, and reporting of the patient selection criteria was poor overall. The most commonly reported clinical symptoms were localized tenderness (60.0%) and edema (53.3%). Direct blow was the most common inciting trauma (46.2%), followed by axial load (30.8%) and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of patients; magnetic resonance imaging and computed tomography were the most common diagnostic modalities. Mean ± SD diagnostic delay was 64.7 ± 89.6 days. Conservative management was pursued in 54.5% of patients, with reported resolution of symptoms in 3 to 6 months. Surgical intervention occurred in 45.5% of patients and resulted in functional restoration in 3 to 6 months in all but one patient. CONCLUSIONS: Initial radiographs for isolated medial cuneiform fractures are frequently occult. Due to expedience and relatively low cost, radiographs are still a viable first-line imaging modality. If clinical concern remains, magnetic resonance imaging may be pursued to minimize diagnostic delay. Conservative management is a viable treatment method, with expected return to full function in 3 to 6 months.

Asunto(s)

RESUMEN

A 20-year-old male military technician reported to a direct-access physical therapy clinic 1 week after falling off a skateboard. His primary complaint was left lateral ankle pain. Following examination, the physical therapist ordered ankle radiographs, which revealed a minimally displaced oblique trans-syndesmotic fibular fracture. J Orthop Sports Phys Ther 2020;50(7):410. doi:10.2519/jospt.2020.9355.

Asunto(s)

RESUMEN

INTRODUCTION: Physical therapy (PT) is a high-volume service that treats musculoskeletal injury and improves return-to-duty rates. Our experience suggests that no-show (NS) and patient cancellation (PC) rates increase the further appointment that is booked in the future, impede access to care, and increase the healthcare delivery costs. The article's purpose is to examine PT National Capitol Region (NCR) appointment data to inform appointment policies. METHODS: We utilized one year of retrospective Military Health System Management and Reporting Tool and Composite Health Care System Ad Hoc Data Pulls to review NCR PT appointment data to evaluate the effect of timing on NS and PC rates. RESULTS: We analyzed 797 new appointments at Walter Reed National Military Medical Center. Data revealed that 16% of patients seen within 10 days NS or PC; 22% of patients seen between 11 and 20 days NS or PC; 28% of patients seen 21 to 30 days NS or PC; and 25% of patients seen over 30 days after consultation NS or PC. We analyzed 182,134 PT appointments (all types) in the NCR. The NS rate was 11.1% (range 8.4-14.9%). CONCLUSIONS: At Walter Reed National Military Medical Center, 17% of new appointments were lost when they were booked over 20 days in advance; additionally, NS and PC rates were greatest after 20 days from consultation.

Asunto(s)

RESUMEN

OBJECTIVES: Medical evidence largely supports PTs in expanded roles, however, healthcare policy within the United States (USA) typically restricts PTs from ordering musculoskeletal (MSK) imaging. It is unknown how MSK imaging policy in the USA compares to other World Confederation for Physical Therapy (WCPT) member nations. The primary objective of our study was to investigate the authority of PTs to order MSK imaging. A secondary objective was to identify factors associated with the authority for PTs to order MSK imaging. METHODS: 111 WCPT member nations were surveyed over a 2-month period on the authority of PTs ordering MSK imaging within their nation. A secondary analysis utilizing a step-wise binary regression compared member nation demographic statistics to MSK imaging authority. RESULTS: 81 member nations responded to the survey. 31 (38.3%) of member nations reported having some level of PT MSK imaging authority while 50 (61.7%) did not. Member nations with lower per capita healthcare costs were significantly more likely to allow PTs to order MSK imaging (p = 0.02). Those with direct access authority were 7.4 times more likely to authorize PTs to order MSK imaging (p < 0.01). Entry-level clinical degree and years of entry-level collegiate credit were not associated with imaging authority. CONCLUSION: This is the first study to report MSK imaging policy within the WCPT member nations. While many nations within the WCPT allow PTs to order MSK imaging, the majority of nations still restrict PTs from such practice. Lower per capita healthcare costs and direct access authority were significant predictors of MSK imaging authority, however, causation cannot be established within the confines of this study. Future studies should consider issues such as restrictive policy origin (i.e. governmental vs. institutional), insurance reimbursement (i.e. private vs. public sector policy), and limitations on imaging modality.

Asunto(s)

RESUMEN

INTRODUCTION: The general practitioner shortage in the United States coupled with a growing number of Americans living with disability has fueled speculation of non-physician providers assuming a greater role in musculoskeletal healthcare. Previous physician shortages have been similarly addressed, and expanding physical therapy (PT) scope of practice may best serve to fill this need. Resistance to expanding PT practice focuses on patient safety as PTs assume the roles traditionally performed by primary care providers. While studies have shown advanced practice PT to be safe, none have compared safety events in advanced practice PT compared to primary care to determine if there are increased patient risks. Therefore, the purpose of our study is to examine the rate of safety events and utilization of services in an advanced practice PT clinic compared to a primary care clinic. A secondary aim of our study was to report safety events associated with spinal manipulation and dry needling procedures. MATERIALS AND METHODS: Productivity and safety data were retrospectively collected from Malcolm Grow Medical Center from 2015 to 2017 for the Family Health Clinic (FHC) and an advanced practice Physical Therapy Clinic (PTC). Chi-square tests for independence, risk ratios (RR) and 95% confidence intervals (95%) were used to compare the relationship between the frequency of (1) patient encounters and clinical procedures and (2) clinical procedures and safety events. RESULTS: Seventy-five percent (12/16) of safety events reported in the PTC were defined as near misses compared to 50% (28/56) within the FHC (RR 1.5; 95% CIs: 1.0 to 2.2). Safety events were more likely to reach patients in the FHC compared to the PTC (RR 1.9; 95% CIs: 0.8 to 4.7). Safety events associated with minor harm to patients was n = 4 and n = 3 in the FHC and PTC respectively. No sentinel events, intentional harm events, nor actual events with more than minor harm were reported in either clinic. Significant relationships indicated that prescriptions, laboratory studies, imaging studies and referrals, were all more likely to be ordered in the FHC than the PTC (p < 0.01). The PTC ordered one diagnostic imaging study for every 37 encounters compared to one in every 5 encounters in the FHC. The PTC similarly referred one patient to another healthcare provider for every 52 encounters, fewer than the one per every 3 encounters in the FHC. There was a significant relationship between encounters and diagnoses, indicating a higher number of diagnoses per encounter in the FHC, though the difference of 0.31 diagnoses per encounter may not be clinically meaningful (p < 0.01). A total of 1,818 thrust manipulations and 2,910 dry needling procedures were completed without any reported safety events. CONCLUSION: These results suggest advanced practice PT has a similar safety profile to primary care. The authority to order musculoskeletal imaging and refer to other clinicians were among the most commonly utilized privileges and may be of primary importance when establishing an advanced practice PT clinic. These results support research showing advanced practice PT may lead to reductions in specialty referrals, diagnostic imaging, and pharmaceutical interventions.

Asunto(s)

RESUMEN

A 25-year-old woman reported to the emergency department with right medial midfoot pain after kicking a wall. Radiographs were noncontributory and the patient was diagnosed with a metatarsal contusion. Persistent pain post injury led her to seek a direct-access physical therapy evaluation. Following examination, the physical therapist requested magnetic resonance imaging, which confirmed a medial cuneiform fracture. J Orthop Sports Phys Ther 2019;49(9):675. doi:10.2519/jospt.2019.8778.

Asunto(s)

Asunto(s)

RESUMEN

A 26-year-old woman was referred to physical therapy with lower back pain extending into the right buttock. Palpation of the right buttock revealed a firm, immobile mass of considerable size, which the patient identified as her locus of symptoms. Due to the noted palpable mass, her pain, her inability to sit normally, and the longevity of symptoms, the physical therapist ordered radiographs, which identified multiple osteochondromas. J Orthop Sports Phys Ther 2017;47(6):442. doi:10.2519/jospt.2017.6877.

Asunto(s)

RESUMEN

The patient was a 31-year-old man who was currently serving in the military. He was referred to a physical therapist by his primary care physician for a chief complaint of left anterior knee pain. Due to concern over a loose body, the physical therapist ordered radiographs of the left knee, which revealed an osseous fragment.

Asunto(s)

RESUMEN

OBJECTIVE AND IMPORTANCE: The purpose of this report is to describe the clinical course of a patient referred to physiotherapy (PT) for the treatment of low back pain who was subsequently diagnosed with metastatic non-small cell carcinoma of the lung. CLINICAL PRESENTATION: A 48-year old woman was referred to PT for the evaluation and treatment of an insidious onset of low back pain of 2 month duration. The patient did not have a history of cancer, recent weight changes, or general health concerns. The patient's history and physical examination were consistent with a mechanical neuromusculoskeletal dysfunction and no red flag findings were present that warranted immediate medical referral. INTERVENTION: Short-term symptomatic improvements were achieved using the treatment-based classification approach. However, despite five PT sessions over the course of 5 weeks, the patient did not experience long-term symptomatic improvement. On the sixth session, the patient reported a 2-day history of left hand weakness and headaches. This prompted the physiotherapist to refer the patient to the emergency department where she was diagnosed with lung cancer. CONCLUSION: Differential diagnosis is a key component of PT practice. The ability to reproduce symptoms or achieve short-term symptomatic gains is not sufficient to rule out sinister pathology. This case demonstrates how extra caution should be taken in patients who are smokers with thoracolumbar region pain of unknown origin. The need for caution is magnified when one can achieve no more than short-term improvements in the patient's symptoms.

RESUMEN

The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. In reviewing left knee radiographs that had previously been interpreted as normal, the physical therapist noted an abnormally deep depression of the medial condylopatellar sulcus, which was concerning for a possible impacted osteochondral fracture. After discussing the radiographic findings with a radiologist, the physical therapist ordered magnetic resonance imaging, which revealed a focal indentation of the anterior portion of the medial femoral condyle with adjacent bone marrow edema that was consistent with an impaction fracture of the medial femoral condyle.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: Diagnosis of patellofemoral pain syndrome (PFPS) is commonly performed using a myriad of clinical and imaging-based criteria. OBJECTIVES: The objective of this systematic literature review was to summarize the research on accuracy of individual clinical tests/findings for PFPS. DATA SOURCES: MEDLINE, ProQuest Nursing and Allied Health, Cochrane Trials, PEDro, and CINAHL. STUDY SELECTION OR ELIGIBILITY CRITERIA: PRISMA guidelines were followed for this review. To be considered for review, the study required: (1) a description of a clinical test or tests used for diagnosing PFPS (including a test that was combined with another finding such as patient history), (2) a report of the diagnostic accuracy of the measures (e.g., sensitivity and specificity), and (3) an acceptable reference standard for comparison. STUDY APPRAISAL OR SYNTHESIS METHODS: Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) scores were completed on each selected article. Sensitivity, specificity, and negative and positive likelihood ratios (LR-/LR+) were calculated for each diagnostic test described. RESULTS: The systematic search strategy and hand search revealed 704 potential articles, 9 of which met the criteria for this review; analysing a total of 22 PFPS clinical tests. After assessment using the QUADAS score, 1 of the 9 articles was of high quality. The tests with the highest reported diagnostic value were also associated with studies that had the lowest QUADAS values. CONCLUSION: A majority of the studies that have investigated diagnostic accuracy of clinical tests for PFPS demonstrate notable design or reporting biases, and at this stage, determining the best tests for diagnosis of PFPS is still difficult.

Asunto(s)

RESUMEN

The patient was a 45-year-old man who was referred to a physical therapist with a chief complaint of posterior right ankle pain for the past 2 weeks. The physical therapist requested radiographs, which demonstrated obliteration of Kager's fat pad, a finding highly suspicious for an Achilles tendon rupture. Based upon history, physical examination, and radiographic findings, the physical therapist ordered magnetic resonance imaging which confirmed the diagnosis of Achilles tendon rupture.

Asunto(s)

Asunto(s)

Asunto(s)