Internet Journal of Allied Health Sciences and Practice
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The Lived Clinical Experiences of Expatriate Athletic Trainers

One of the ways that healthcare systems have adapted to the needs of patient care is to expand the role of allied healthcare professionals. The utilization of these clinicians, with wide-ranging skill sets, allows for increased adaptability and improved patient outcomes.1 Expansion of physician reach through allied health professions provides improved connectivity to patients.2 While medical communities all have a common goal, the healthcare system varies among nations in terms of the representation of allied healthcare professions.2 Within the United States (US), one of the most versatile allied health professions is athletic training. With a skill set that can extend the primary care of physicians to a range of settings, athletic trainers (ATs) have become an asset to healthcare systems.3-5 ‘Global Health’ is defined as the interdisciplinary sphere of prevention, treatment, and care. The definition spans beyond the medical concerns addressed by the World Health Organization (WHO) whose primary focus is to address large public health disparities and communicable disease control.6,7 The definition of global health includes clinicians working hands-on with patients to address nutritional deficiencies, obesity, industrial health, injury prevention, and the safety of migrant populations.7 The laws and expectations created by the WHO are often unclear and have low enforceability, demanding a ‘synthesis of population-based prevention with individual-level clinical care’ to address health needs.7 Allied healthcare providers are essential to the front line care of this model.2 These providers are equipped and ready to address trans-national problems on domestic levels from their specialization in some of the most pressing global health concerns including disaster relief and emergency care, musculoskeletal pain and disability, care of military and first responder personnel, and work optimization.2,7 The most common allied health professions within underdeveloped countries are those of rehabilitation and disability management.8 Occupational and physical therapy specialties have stated that rehabilitative professionals have an ethical duty to serve the world’s populations of poverty and disability.8 The Bone and Joint Decade of 2000-2010 was established and endorsed by the WHO and the United Nations (UN) to address growing concerns for the impact of musculoskeletal diseases and disabilities.9 This international mandate increased awareness around the impact of pain and disability, leading subsequently to the advancement of therapeutic and rehabilitative professions.10 The advances of these professions further heightened the need for international musculoskeletal collaboration, including the expatriation of allied health professionals.9 Providing health care in settings beyond athletics allowed US ATs to gain notoriety as valuable primary care providers in a variety of settings.11 The term athlete has expanded to include all those active in their work or lives including performing arts, industrial, and tactical athletes.3 In addition, the definition of an athlete can include all general populations with musculoskeletal burdens commonly seen in clinic settings with no specification of athleticism.3,4 This growth allowed ATs to be utilized in the US healthcare system as primary care providers, far beyond the sport field.3 This versatility has led the athletic training profession to seek globalization to match the recognition of other allied health professions on the international stage.12 While studies have been performed to investigate similarities in educational standards and practice patterns of US-ATs abroad, no investigation has yet to look at the lived experiences and adaptations of these individuals working abroad.13 Understanding the work these expatriate professionals do in a variety of different countries is crucial to establish a baseline of knowledge for the future of international athletic training. Therefore, the purpose of this investigation was to explore the lived experiences of US-ATs working as clinicians abroad.

https://nsuworks.nova.edu/ijahsp/vol22/iss3/26

Director of Clinical Education Training in Doctor of Physical Therapy Programs

Purpose: Directors of clinical education (DCEs) need knowledge and skills in many areas to succeed in their roles.Not only does the DCE need to master the traditional faculty roles of scholarship, service, and teaching, but the DCE also needs to become competent in administrative duties. Lack of training, especially in research, can negatively affect the DCEs’ ability to perform their responsibilities effectively and efficiently. In this study, we aimed to examine how DCEs learn their numerous roles and how training and experience influence self-perceived competence. Method: In this quantitative, non-experimental study, we used an online survey to obtain information from 143 DCEs for Doctor of Physical Therapy programs in the United States. We examined the data obtained from the surveys using descriptive statistics, Mann-Whitney U tests, regression analyses, and scatterplots. Results: The primary way DCEs reported learning their role was through mentorship. Respondents reported inadequate training for their administrative, scholarship, service, and teaching workloads but reported feeling competent in all workloads except scholarship. Those with an academic doctorate described significantly higher perceived competency in all workload categories than those without an academic doctorate. Training and experience influenced the perceived competence of the DCE. Only training, not experience, was independently associated with perceived competence for scholarship tasks. Conclusion: For DCEs new to academia, formal training and mentorship, especially in scholarship, should be considered when designing a DCE’s onboarding. Reduction in expectations for non-clinical education activities may be needed until a DCE has gained experience and learned to perform their role competently. Another method for DCEs to master their role is obtaining an academic doctorate, as this positively impacts the DCEs’ perceived role performance.

https://nsuworks.nova.edu/ijahsp/vol22/iss3/24

Perspectives Of Medical And Dental Undergraduate Students On Educational Strategies During And Post Covid-19 Lockdown

Introduction After the emergence and declaration of Covid-19 as a pandemic in March 2019, many countries implemented lockdown with cessation of essential and non-essential activities including educational and academic processes, in order to restrict the spread of the disease,. This necessitated the shift of education from face -to-face conventional methods towards online teaching and assessment practices in all domains, including medicine. This study determined the perspectives and level of satisfaction of medical and dental undergraduate students regarding the online teaching and assessment modes practiced during and after Covid-19 lockdown period. Method: The study was conducted at various medical and dental colleges of Karachi, with a calculated sample size of 500. Data was collected with the help of a structured questionnaire on Google forms and the link which was shared with students through different social media platforms. Results/Conclusion: The majority (52.5%) of the students were not satisfied with the online teaching provided to them during the Covid-19 period and the most common issue encountered was difficulty in concentration. Recommendations: The teaching institutes should emphasize on proper training of the instructors and improve the online teaching system in order to deliver academic content effectively.

https://nsuworks.nova.edu/ijahsp/vol22/iss3/23

A Comparison of Menstrual Health and Well-Being among Adolescent Girls in Urban and Rural Areas of the Belegavi District: A Crossectional Study

Background: Due to their relationship with several health hazards, menstrual hygiene management (MHM) and awareness are major public health concerns in both urban and rural settings. This study examined the awareness of MHM among adolescent girls in Belagavi and assessed their knowledge and understanding of menstruation and related taboos.

Methods: In the Belagavi District of Karnataka, India, a cross-sectional, community-based observational study was carried out. About 380 (as 8 were excluded) menstruating adolescent girls between the ages of 12 and 18 who attended different convent and government schools were included in the study. IBM SPSS version 20 was used to analyse the data from a self-reported questionnaire about menstrual hygiene, taboos, behaviours, and well-being.

Outcome measures: The knowledge and awareness of menstrual hygiene and practice in adolescent girls were evaluated using the MPNS 36 Scale and the WHO 5 well-being index.

Results: The knowledge and awareness of menstruation hygiene were significantly lacking in girls from both urban and rural regions (p = 0.0001). Compared to 83.90% of girls in rural areas, 72.26% of girls in urban areas were ignorant of menstruation and the accompanying hygiene practices. According to the between-group study, urban females demonstrated marginally more knowledge than rural girls (p=0.0001). In both urban and rural areas, the girls experienced various menstrual restrictions, with 320 (84.21%) of the girls experiencing limits during their cycles.

Conclusion: The study finds numerous taboos and a lack of knowledge regarding menstruation hygiene, impacting adolescent girls' well-being in urban and rural settings. As a result, it suggests including basic education for adolescent girls in both their home and academic environments.

Keywords: Menstrual hygiene, menstrual awareness and knowledge, menstrual practice, menstrual taboo, MPNS-36 scale, WHO 5 well-being index, Adolescent girls.

The Cognitive and Affective Empathy of Doctor of Physical Therapy Students vs. Specialty Choice

Purpose: This modified cross-sectional study was performed to determine which specialties DPT students desire to enter, and how affective and cognitive empathy is related to the specialty choice. There are two types of empathy: affective and cognitive. Affective empathy from an emotionally charged situation enters the CNS of a person first and is followed by a cognitive empathic response. Methods: Affective empathy was measured using the Balanced Emotional Empathy Scale (BEES) and cognitive empathy was measured using the Jefferson Scale of Empathy-Health Professions Student (JSE-HPS) version. Each student was asked to indicate which specialty they desired to enter: cardiopulmonary, geriatrics, musculoskeletal/orthopedics, neurology, or pediatrics. The cohort consisted of first, second, and third year DPT students during the 2021-2022 academic year. Each survey instrument was given to each cohort at the start and end of their respective academic year. Results: Most students, regardless of sex or program year, desired to enter a musculoskeletal/orthopedic specialty. Very few enter cardiopulmonary or geriatric specialties. The affective empathy scores of most specialties are at the population norm, except for students entering neurology and pediatrics where their BEES scores are considered “slightly high.” For cognitive empathy scores, males who selected musculoskeletal/orthopedics or neurology had significantly lower JSE-HPS scores than females selecting neurology. Although there is no population norm for cognitive empathy, the JSE-HPS scores can be compared to those of third- and fourth-year osteopathic students in the nationwide Project in Osteopathic Medical Education and Empathy (POMEE) study; in this case, the DPT graduates are at the 52nd percentile. Conclusions: Similar to other DPT programs, many students desire to enter musculoskeletal/orthopedics, with few selecting cardiopulmonary or geriatrics. Neurology attracts students with higher levels of affective and cognitive empathy. The relative homogeneity of cognitive empathy scores in the various DPT/Physiotherapy programs previously studied suggests similar cadres of students, regardless of where they originate, are being selected to enter the programs.

Evaluating the Role of In-Person and Virtual Poverty Simulations in Promoting Empathy Among Healthcare Students Before and During the COVID-19 Pandemic

Purpose: The purpose of this study is to evaluate whether differing poverty simulation formats during the first year of didactic training increase healthcare students’ empathy toward and/or understanding of people living with poverty. Methods: Data collected from 2019 and 2021 poverty simulations was retrospectively analyzed to determine the impact of in-person and virtual simulations on the understanding of poverty. Pre-simulation surveys were compared to detect potential differences in empathy due to the emergence of COVID-19. The 2019 simulation was performed in-person utilizing the Missouri Association of Community Action (MACA) simulation kit. The 2021 simulation was performed virtually due to COVID-19; students played SPENT© online. The 2010 Attitudes Toward Poverty (ATP) Scale was administered as pre- and post-surveys to determine change in student perceptions. The survey contained three domains (personal deficiency, stigma, and structural perspective). Students who completed both the pre- and post-surveys were included in the analysis. A paired samples t-test was performed to compare mean scores. Results: A total of 244 students from six different disciplines were included in the analysis: 90 students (37%) from 2019 and 154 students (63%) from 2021. Significant changes demonstrating improved attitude were noted in personal deficiency and stigma domains. For the stigma domain in the 2021 group, the pre-simulation mean score (M = 3.63, SD = 0.72) was significantly lower than the post-simulation mean score (M = 3.80, SD = 0.69), p<0.01. Comparison of pre-survey mean scores revealed significantly higher scores for 13 of 21 items demonstrating increased baseline empathy in 2021. Conclusion: Regardless of format, poverty simulations can be a beneficial educational experience to increase empathy towards people living in poverty. Personal experiences, including living through a pandemic, can have an impact on student empathy. Schools should consider offering a poverty simulation to enhance values and ethics of healthcare students.

Bilateral Inguinal Hernias versus Osteitis Pubalgia: A Case Study

A 31-year-old male ice hockey player presented with symptoms consistent with bilateral inguinal hernias further confirmed with imaging. After undergoing surgical excision, the patient continued to report pain. Further evaluation determined the patient’s pain seemed to be concentrated around the pubic region. Upon MRI reassessment, the patient demonstrated mild inflammation of the pubic symphysis from osteitis pubalgia (OP). Following this diagnosis, a new course of treatment was delivered with symptom elimination. This treatment was a methylprednisolone acetate 40 mg injection into pubic symphysis. It is essential to take into consideration not only the physical presentation, but also the activities that exacerbate the pain when making a diagnosis. Ice hockey includes repetitive motion from rapid acceleration, deceleration, and cutting on the ice, causing compression and separation at the pubic symphysis and inferior/superior glide. The constant shearing forces result in inflammation and dysfunction. Additionally, the muscular attachments at the pubic symphysis include pectineus, rectus abdominis, adductor longus, adductor brevis, and gracilis. Therefore, an injury to those muscles may cause secondary dysfunction of the pubic symphysis. Although the inguinal hernias were successfully treated, ultimately the patient’s pain resulted from OP, common in ice hockey. Given the close proximity of the pubic symphysis and muscular attachments to the inguinal canal, the likelihood of pubic symphysis stress is considerable. Given the close proximity of the pubic symphysis and muscular attachments to the inguinal canal, the likelihood of pubic symphysis stress is considerable. In cases like this, it raises the pivotal question: Which condition preceded the other? Was osteitis pubis (OP) pre-existing before the surgery, or did a pre-existing mild dysfunction of the pubic symphysis exacerbate following inguinal hernia repair? The challenge lies in the overshadowing effect of inguinal hernias on the diagnosis of OP. While imaging studies readily detect hernias, OP often eludes detection, particularly on MRI, and tends to be overlooked, especially when not initially suspected. Thus, while physical presentation and imaging remain crucial, recognizing physiological motion and predisposing factors is paramount for arriving at a comprehensive diagnosis.

Long COVID Among Young Adults: Findings from the Household Pulse Survey

Purpose: Substantial research has been completed to describe the prevalence and risk factors associated with COVID-19. However, less attention has been given to persisting symptoms beyond three months. These persisting symptoms defined as long COVID include fatigue, difficulty thinking or concentrating, memory problems, mobility issues, difficulty seeing, trouble hearing, shortness of breath, and dizziness. Further, less attention has been given to young adults who are more likely to experience mild forms of COVID-19 and potentially differential effects of long COVID. The purpose of this study was to examine the prevalence of young adults experiencing long COVID symptoms and explore the long-term effects that these persisting symptoms may have on their lives. Methods: Long COVID symptoms were assessed through the Household Pulse Survey developed by the US Census Bureau during the pandemic. Participants were asked about their experiences with both COVID-19 and long COVID. Results: Fifty-two percent (52.4%) of individuals under the age of 45 that reported having COVID-19, and 32.1% of these individuals also reported experiences with long COVID. The most common long COVID symptoms among those < 45 included memory issues (17.8%), trouble seeing (5.6%), and mobility issues (4.8%). Conclusions: These findings suggest a critical need to further examine long COVID in young adults due to the high prevalence of long COVID and the potential impact these long-term symptoms may have.

Stakeholder Involvement and Systematic Review of Elements that Determine a Successful Return to Work for Injured Workers: A Scoping Review

Introduction: A healthy and sustainable return to work (RTW) for a worker after injury or illness has benefits for the worker, their family, the employer, and society.1 For this research we used the following definition of RTW success; return to positive and meaningful work in a position or occupation not necessarily including all the aspects of the worker’s pre-injury or pre-illness functions or tasks. Purpose: The question behind this survey-based research was, What elements are perceived as essential, to ensure return to employment of injured or ill workers, by stakeholders with experience in the RTW process? Methods: A 32 item Likert style online survey on RTW elements was developed. An email invitation to participate was distributed, with anonymity guaranteed the participants. The respondents to the survey (n = 93) identified themselves as injured workers (n = 23), family members (n = 10), employers (n = 11), healthcare professionals (n = 31), insurance providers (n = 5) and occupational health specialists / RTW coordinators (n = 13). Results: The top 5 elements ranked at ≥75% by all stakeholders as ‘very important’ were the injured worker’s access to subsidized assistance/benefits; the availability of modified tasks/duties in the workplace for the injured worker; the injured worker’s commitment to rehabilitation; the support of the healthcare providers in RTW; and the availability of modified work hours/schedule for the worker. Conclusions: The results of this survey-based research support the idea that it is important to consider both environmental and personal factors of the worker in the RTW process.

Lifestyle Medicine for Allied Health Students: A Pilot Study of an Online Program

Purpose: Allied health students may experience a range of academic, financial, and social stressors which negatively impact their health and well-being. During the COVID-19 pandemic, additional threats to student health and well-being were introduced. Therefore, the purpose of this study was to pilot an online lifestyle medicine program for enhancing students’ physical, mental, social, and spiritual health. Method: This study employed a quasi-experimental, mixed-method study to test the effectiveness of an online health program. Participants engaged in a four-week lifestyle medicine program titled “5 Minutes to a Healthier You.” Participants completed the Depression, Anxiety, and Stress Scale (DASS-21) and the Health-Promoting Lifestyle Profile II (HPLP-II) before and after the program. Additionally, they completed a 7-item post-program survey and engaged in semi-structured interviews approximately one month post participation. Results: Thirty-one (31) students were enrolled in the program with 10 completing both pre- and post-assessments, and four engaging in the semi-structured interview. Program participation resulted in a statistically significant decrease in anxiety and increases in healthy behaviors among allied health students. Four themes emerged from the post-program interviews including “Program Effectiveness,” “Insight and Desire for Health,” “Barriers and Supports to Health,” and “Program Structure.” Conclusions: Findings from this pilot study suggest that a four-week online program centered on lifestyle medicine may positively impact allied health students’ physical, mental, and emotional health. Recommendations: Allied health students may benefit from engaging in brief health programming which emphasizes principles of lifestyle medicine, personal goal setting, accountability, and guidance from an occupational therapist.

Rethinking Disability Simulations for Occupational and Physical Therapy Students: Integrating the Social Model of Disability

Purpose: Disability simulations traditionally have been used in many healthcare profession educational programs with the intent to foster empathy and positive viewpoints towards people with disabilities. However, research is inconclusive regarding the effectiveness of these activities. The appropriateness of these activities has also been called into question when considering disability as a form of diversity and social justice, with recommendations to utilize the Social Model of Disability to frame activities. Methods: A mixed-methods study was conducted to explore the efficacy of a temporary orthopedic injury simulation assignment on first-year occupational and physical therapy students’ viewpoints regarding working with people with disabilities and its overall impact on their professional development. Pre- and post-simulation responses to the Multidimensional Attitudes Scale toward Persons with Disabilities (MAS) were analyzed. A phenomenological approach was utilized during the coding and thematic analysis process of completed written or videotaped student reflections, submitted as an assignment within a clinical skills course. Reflection prompts utilized the Social Model of Disability with a focus on the influence of physical and social environment and successful activity completion throughout the day. Results: Participants only noted a statistically significant change in affect on the MAS with no other statistically significant changes noted in attitudes towards people with disabilities. Qualitative data indicates increased awareness of the impact of a mobility device on daily activities and social interactions, impact of environmental accessibility, use of compensatory strategies to successfully complete daily tasks, and the importance of client education, training, and empathy as a clinician. Conclusions/Recommendations: Results align with past studies regarding the inconclusive nature of the true impact of disability simulation activities on healthcare students and their attitudes towards people with disabilities that could impact healthcare provision. Continued attention to framing is required to ensure lack of negative stereotype reinforcement, and programs should closely examine the intended learning outcomes of the lessons typically learned during these types of activities. In keeping with best practices, disability simulations should not be standalone activities but be accompanied by debriefing, lived experience accounts, and other activities to fully address these concerns.

Gait Initiation Alone May be Insufficient to Identify a Neuromuscular Mechanism Underlying Concussion-Related Kinematic Alterations

Purpose: Concussions create significant long-term health consequences, such as kinematic alterations, which may contribute to lower extremity musculoskeletal injury, dexterity limitations, disability, and declines in quality of life. A potential movement test that may identify neuromuscular mechanisms underlying these kinematic alterations is gait initiation. Gait initiation can assess preparatory postural adjustments as an individual transitions from static balance to voluntary movement. Thus, this study aims to examine muscle activation latency of individuals who sustained a concussion 3 to 24 months prior to testing, compared to healthy controls, during gait initiation tasks. Methods: This case-control study included 32 individuals who sustained a concussion 3 to 24 months prior to testing and 28 healthy controls who completed five trials of gait initiation. Participants were fitted with electromyography sensors on their right vastus medialis, semitendinosus, tibialis anterior, and medial gastrocnemius to identify a potential neuromuscular mechanism underlying kinematic alterations. A series of ANCOVAs were utilized to identify group differences in muscle activation latency of the vastus medialis, semitendinosus, tibialis anterior, and medial gastrocnemius; reaction time; preparatory center of pressure (COP) path length; preparatory COP velocity; initial step length; mini-mental state examination score; Montreal Cognitive Assessment score; concussion symptom score. Results: Data collected in the current study displayed no group differences in muscle activation latency of the vastus medialis, semitendinosus, tibialis anterior, and medial gastrocnemius, reaction time, preparatory COP path length, preparatory COP velocity, or initial step length (p>0,05). However, the data did reveal significant group differences to cogitative measures (mini-mental state examination score; Montreal Cognitive Assessment score) and concussion symptom score. Individuals who sustained a concussion displayed worse cognitive performance and greater concussion symptoms. Conclusion: Gait initiation tasks alone may not be challenging enough to elicit observable neuromuscular alterations following concussion. Future research should continue to identify diagnostic tests to identify the neuromuscular mechanism underlying concussion-related kinematic alterations to improve the quality of life of individuals who sustain a concussion.

Undergraduate Allied Healthcare Professional Students’ Perceived Knowledge of Children with Autism Spectrum Disorder

Purpose: Allied healthcare professionals are key stakeholders involved in managing children with autism spectrum disorder. Adequate knowledge, interprofessional education, and collaborative practice should therefore be fostered through a responsive curriculum from an undergraduate level. This study aimed to describe the knowledge of final-year undergraduate allied healthcare professional students from a South African university regarding risk factors, symptoms, and intervention considerations for children with autism spectrum disorder. Method: A cross-sectional e-survey design was implemented, and data were analyzed using descriptive statistics and content analysis. The e-survey was distributed to 170 undergraduate students. Results: A total of 59 participants from the following study programs completed the survey: Audiology (n=10), Human Nutrition (n=6), Occupational Therapy (n=5), Physiotherapy (n=10) and Speech-Language Pathology (n=28). Overall, participants perceived their knowledge of autism spectrum disorder to be poor-to-average (71%; N=42). Participants identified the disorder’s symptoms (69%; N=41) more accurately compared to risk factors (51%; N=30). Discrepancies across study programs were apparent regarding when to initiate intervention. Participants showed substandard understanding of evidence-based intervention approaches (47%; N=28). Across study programs, participants were unaware of the roles other allied healthcare professionals played in service provision areas. Conclusions: This study identified multiple gaps in the students’ knowledge across all study programs regarding risk factors and symptoms, screening, accurate multidisciplinary, referrals as well as timely intervention. Recommendations: Future undergraduate curricula should therefore focus on disorder-specific and in-depth knowledge, while including interprofessional and collaborative service provision as autism spectrum disorder requires multidisciplinary management.

Extending Pain Psychology Beyond the Psychologist: The Need for a Professional Clinical Identity

This paper outlines the argument for establishing a commonly understood designation for allied health clinicians who specialize in psychological interventions for chronic pain. There is a growing need for clinicians with skills in psychological interventions for pain (“pain psychology”). However, there are not enough pain psychologists to meet the demand. Recent research has suggested that allied health professionals from varying disciplines can safely and effectively deliver pain psychology interventions. Clinical training in psychological interventions for pain outside of clinical psychology has been growing but remains limited. As the pool of cross-discipline clinicians with expertise in pain psychology expands, this specialization would benefit from developing a shared professional clinical identity. A clear and descriptive nomenclature would facilitate learning and collaboration across disciplines, and clarify the role’s clinical utility for patients, insurers, and other allied health professionals. Standards for training, licensure, and orientation to evidence-based and patient-centered care should be outlined and agreed upon. The establishment of a professional clinical identity for clinicians across disciplines who specialize in pain psychology is a critical step in improving patients’ access to safe and effective pain management.

The Benefits of Peer Visitation on the Rehabilitation of New Amputees: A Qualitative Study

Purpose: For the purpose of this study a peer visitor is being defined as someone who has experienced some type of limb loss and is now mentoring other amputees. Their focus is on health and recovery as opposed to illness as they listen, provide emotional support, and most importantly inspire hope in an individual who has experienced a new amputation. The primary purpose of this study is to examine the reports of amputees regarding their personal experiences related to whether they spoke with a peer visitor following surgery. The study focuses on the benefits of peer visitation and how it impacts rehabilitation outcomes. Methods: This study utilizes a qualitative methodology, and in response to the research questions the benefits of phenomenological research will provide thoughtful and compelling representations of the different lived experiences from all participants. The sample for this study was drawn from across the U.S with the assistance of a local Hanger Inc. clinic, and the Amputee Coalition of America. The primary data collection tools for the investigation were in-depth, audiotaped interviews and a pre-interview questionnaire. All interviews were conducted either over the phone or through a Zoom platform. Results: Findings revealed that peer visitation improves coping strategies for anxiety and depression following surgery, increases confidence and hope in the patient, and influences mental health recovery. Conclusions: Based on the findings it was concluded that a peer visitor will improve overall mental health, improve patient attitudes, and overall improve rehabilitation outcomes for new amputees, and it is plausible to generalize these conclusions to the entire population of amputees. This study empowers new amputees and healthcare practitioners with knowledge to seek out a peer visitor following surgery, as it can improve the outcome of the patient’s rehabilitation.

Cultural Competence with Humility: A Pre-Post Cohort Study of Student Self-Assessments

Purpose: The intent of this study is to examine how Master of Occupational Therapy (MOT) and Counseling and Human Development (CHD) graduate students who experienced Counselors and Occupational Therapists Professionally Engaged (COPE) in the Community program perceived their self-evaluation of cultural competence with humility (CCH) constructs (cultural awareness, skills, knowledge, and desire) from pre- to post-experience. Methods: Using a pre-/post-test cohort design, researchers used the Modified Cultural Competency Self-Assessment (M-CCSA) to determine if there were changes in ratings after students completed a novel training program. Results: Twenty-five students completed the pre-/post- survey. Overall, the mean M-CCSA total and subsection ratings on the post-COPE program were higher than the pre-COPE program with 14 of 25 (56%) students rating themselves higher on CCH variables after completing the COPE program. The mean difference (MD) score was statistically significant for the Cultural Skills subsection (MD = .19, t(24)= 2.69, p = .01, d =.36) with a small effect size. The Cultural Desire secondary analysis (MD = .20, t(24)= 1.75, p = .09, d =.57) approached statistical significance with a moderate effect size. The MD was not statistically significant for the M-CCSA total score (MD = .10, t(24)= 1.24, p = .23, d =.25), Cultural Awareness subsection (MD = .07, t(24)= .60, p = .56, d =.60), and Cultural Knowledge subsection (MD = .03, t(24)= .42, p = .68, d =.40). Conclusions: Students' overall M-CCSA increased after completing the COPE program. The results suggest that the COPE program may have positively influenced students' development of CCH (cultural awareness, knowledge, skills, and desire). This research adds to the existing body of evidence suggesting that interprofessional multicultural learning activities are beneficial to learning CCH.

Civic-Mindedness and Core Values Ratings across Three Cohorts of DPT Students: Impact of Covid19

Purpose: The American Physical Therapy Association (APTA) defines expected professional behaviors beyond legal and ethical expectations in the Core Values document. Civic mindedness may be related to core values. Civic-minded professionals have strong ethics and work cooperatively to promote the general welfare of others. Doctor of Physical Therapy (DPT) education programs use a variety of methods to develop professional behaviors, Core Values, and civic mindedness in students, including experiential service-learning. The purpose of this study was to describe the trajectory of civic mindedness and core values over the course of a three-year DPT program in three cohorts of graduate students. Methods: Three cohorts of DPT students were surveyed using two established tools at the beginning and completion of the didactic portion of the curriculum. The Civic-minded Professional Scale (CMP) provides an overall score as well as 5-subscale scores measuring constructs of consensus building, voluntary action, identity and calling, and being a social trustee; higher scores indicating greater levels of civic-mindedness. The APTA Professionalism in Physical Therapy: Core Values self-assessment (PPTCV) measures accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility. Results: The classes of 2021 and 2022 had scores increase or remain stable across the CMP and PPTCV but the class of 2023 total and subscale scores either significantly decreased or remained stable from pre-test to post-test. Conclusions: The shift to indirect and electronic service-learning during the pandemic may have negatively impacted the development of civic mindedness and physical therapist core values in the class of 2023. These deficits could impact graduates in early clinical practice in both professional behaviors and civic-mindedness.

Measuring Similarities Between the Patient Specific Functional Scale and Physical Therapist-created Long-term Goals in Outpatient Physical Therapy

Background: The Patient-specific Functional Scale (PSFS) can be used to promote person-centered goal setting. This study aimed to determine how often PSFS Items and Target Activities from physical therapist-created long-term goals (PTC-LTG) agreed. The relationship between patient demographics, meeting/partially meeting PTC-LTG and meeting or exceeding the minimal clinical important difference (MCID) for PSFS activities was also investigated. Method: PTC-LTGs, patient demographic questionnaires, and pre/post-physical therapy intervention PSFS were collected. Each item in PSFS and Target Activity in PTC-LTGs was linked to a World Health Organization International Classification of Function (WHO ICF) category. A regression analysis determined if there was a relationship between the patient’s demographics and the achievement of the PSFS and PTC-LTG. Results: Seventy-eight items identified on the PSFS and 85 PTC-LTGs from 21 subjects were linked to ten of the 30 WHO ICF chapters. The PSFS items were often linked to Activities/Participation, whereas PTC-LTG Target Activities were linked to Body Functions. Of the Target Activities, 10.2% matched items in seven patients. Demographic characteristics were not associated with achieving MCID for PSFS or meeting PTC-LTG. Conclusion: Our study has shown that patients identified Activity Limitations on the PSFS more often than physical therapists (PT) who selected Body Function impairments as the Target Activity for long-term goals. The lack of agreement may be related to PT’s engagement of patients and their PSFS items during goal setting. Future research will address how the PSFS items and scores are used to support patient-centered goals.

The Effects of Debriefing Methods on Athletic Training Students’ Self-Efficacy

Purpose: Simulation-based education is a teaching method used successfully in nursing and medical education, as well as in the military and aviation fields. It provides students with safe learning environments and opportunities to practice skills not seen or used during clinical rotations. Debriefing is an essential component of simulation where learning occurs while also fostering critical thinking, clinical reasoning, and promoting self-efficacy with clinical skills. However, the evidence rarely indicates which debriefing method is best at increasing clinical evaluation skills self-efficacy. The purpose of this study was to compare the effects of debriefing methods on students’ clinical evaluation self-efficacy. Methods: In this quasi-experimental, retrospective pretest-posttest study the researcher explored the effect of four common debriefing methods on students’ clinical evaluation self-efficacy. Using the Confidence Rating Scale, the researcher collected students’ self-efficacy scores before and after a simulated experience with debriefing through an online survey that was distributed to current athletic training students. Results: The analysis did not find any statistically significant relationship between the type of debriefing method and pretest self-efficacy. There were also no statistically significant relationships found between the type of debriefing and students’ pretest to posttest changes in self-efficacy. Conclusions: The literature recognizes that debriefing is the component of simulation where learning occurs, but there remains minimal research on which debriefing method is the best at increasing students’ self-efficacy.

The Perceived Benefits of International Travel for Occupational Therapy Practitioners Who Have Traveled Internationally

Purpose: This qualitative study aimed to examine the perceived benefits of international travel for occupational therapy practitioners who have traveled internationally during their occupational therapy education or career. To succeed, healthcare professionals must have various personal and clinical skills, including providing quality care to diverse populations. They must have cultural competence, which includes cultural humility and cultural sensitivity. Methods: A purposive, convenience sampling was used through a network of occupational therapy practitioners who had previously traveled abroad either as occupational therapy students or as licensed occupational therapists and participated in education, clinical experience, work experiences, or volunteer experience related to occupational therapy. Individually, eight participants meeting the criteria were asked 12 open-ended questions through virtual interviews focused on the potential impact of international travel on developing and enhancing personal and professional competencies. The research team transcribed, coded, and placed responses into categories to create significant themes. Results: Four major themes were identified: (1) personal growth; (2) professional growth; (3) application to occupational therapy practice; and 4) increased cultural awareness. Conclusions: Through international travel, healthcare professionals may gain a more global perspective, improve cultural sensitivity and cultural humility, increase flexibility in practice to improve client outcomes with limited physical and financial resources, and strengthen the desire to participate in advocacy efforts. Although the cost may be a barrier to requiring travel for higher-education students, innovative funding may help create opportunities to serve client needs better.

Student Physical Therapists’ Perceptions of a First Semester Integrated Clinical Experience: A Descriptive Study

Purpose: The value of an Integrated Clinical Experience (ICE) is well documented, but student physical therapists’ perspectives of an early ICE are not. A first semester ICE allows practice of expected skills and behaviors from the onset of a professional program. The purpose of this study was to explore students’ perceptions of a first-semester ICE. Methods: A questionnaire was completed by 36 student physical therapists after a first semester part-time ICE. SPSS Statistics, thematic analysis, and a mixed-methods approach were used to analyze the data. Results: Students agreed the ICE emphasized the importance and allowed practice of professional and communication skills (SD = 0.6 – 0.8, IQR = 1) and psychomotor and documentation skills (SD = 0.8 – 1.0, IQR = 0 – 1.25). All students agreed that applying the International Classification of Functioning, Disability and Health (ICF) model to a patient vignette increased their understanding of ICF model usage. Thematic analysis revealed students enjoyed working with actual patients, positive qualities of the Clinical Instructor (CI), and applying skills learned in class. Drawback themes included the ICE being too early in the program or students having limited professional knowledge, the ICE being too short, and the CI not involving the student in patient care. Conclusion: A first semester ICE provides an almost immediate opportunity for students to experience clinical expectations and transition from the roles of observers to student physical therapists. Given the advantages and no existing evidence of benefits to wait beyond the first semester to employ the first ICE, programs should consider incorporating a PTICE in the first semester.

Teaching Exercise Physiology with Flipped Classroom Method in The Era of COVID-19: Experience of a Remote Course

Purpose: The purpose of this article is to describe the use of flipped classroom method in a forced remote Exercise Physiology course during the COVID-19 pandemic and assess the students’ motivation and learning throughout the course. METHODS: Undergraduate students received recorded asynchronous activities each week that should be done before a weekly synchronous meeting. During synchronous and asynchronous activities, strategies to emphasize students’ active participation were applied. Weekly, learning evaluation activities were applied, and the motivation was assessed. At the end of the course, students’ motivation and learning about each activity were evaluated. RESULTS: Of the 14 course topics, 2 were rated as “extremely motivated”, 11 as “very motivated” and 1 as “motivated”. Furthermore, motivation was positively correlated with learning, and students attributed high scores to all activities, except for group activity. CONCLUSION: The flipped classroom methodology employs different active teaching strategies, motivates, and contributes to students learning, an option to remotely teach exercise physiology.

Educational Lessons from a Pandemic: Lecture Recording and Learning Outcomes

Purpose: The use of lecture capture (LC) in higher education classrooms has increased, especially since the onset of the COVID-19 pandemic; however, its effectiveness as a learning strategy is largely untested in graduate students. In undergraduate students, the use of LC has mixed findings related to academic performance. Some studies show no improvement in assessment or course grades while others show small gains. The purpose of this study was to investigate the impact of LC on academic performance in graduate doctor of physical therapy students (DPT). Methods: In module 1, students received two virtual synchronous lectures which were recorded and uploaded to the learning management system (LMS). A sample of convenience of second year DPT students enrolled in a cardiovascular and pulmonary course. Scores on quizzes and exams and viewing data were extracted from the LMS, and students completed a survey about their experience with LC. A Mann-Whitney U was performed to compare grades amongst students who watched recordings versus those who didn’t. A linear regression was performed to determine if a duration of video viewing was associated with better performance. A similarity test was used to compare the quiz and exam scores for module 1 and module 2 for those students who watched one video or two videos. Results: Fifty-eight students met inclusion criteria (58/67). No duration of video viewing was associated with better performance on the quiz (p= 0.423) or unit exam (p=0.754). There were no significant differences between students who watched the recorded lectures and those who did not on either quiz (p=0.732; Table 3) or exam performance (p=0.773; Table 3). Lastly, the similarity scores for those who watched both videos were a 0.98 for the quizzes and 0.92 for the exams, again showing similar performance whether or not students viewed the videos. Conclusions and Recommendations: No performance advantage was found for viewing recordings despite students' positive perception of their utility. Professors should recommend the best-fit learning modality for each student, as LC may not be of benefit.

The Clinical Placement Process Through the Lens of the Director of Clinical Education: A Qualitative Multiple Case Analysis

Purpose: The placement process is a key contributor to current challenges in health science clinical education. The Director of Clinical Education (DCE) is the central figure in coordinating the placement process in physical therapist education. Despite their central role, there is no research exploring the DCE perspective during this process. The purpose of this study was to explore the DCE’s experience in navigating the placement process to further understand how the DCE role is impacted by barriers and facilitators encountered during this process. Methods: Fourteen DCEs representing private and public institutions from across the country participated in the study. Using a multiple case analysis approach, semi-structured interviews were conducted with each participant. Interview transcripts underwent thematic analysis using a team-based coding approach to identify categories and themes. Results: Five themes with eighteen associated categories represent the interconnectedness between the DCE’s approach to the placement process and their experience throughout. The five themes are: Prolonged Process, Sense of Competition, Leveraging Relationships, Student Centeredness, and Clinical Site Considerations. Conclusions: This is the first study to examine the DCE’s experience in a specific aspect of their faculty role. The placement process is a core component of the DCE’s responsibilities, and its inherent complexities and prolonged nature impact the DCE’s workload and overall experience as a faculty member. Supporting the DCE in this process can have a positive impact on the student experience, and relationships between academic programs and clinical sites, and the DCE’s satisfaction in their role, Findings from this study can be used to address challenges faced by DCEs and other faculty in other health sciences professions that are involved in the clinical placement process.

A Perfect Storm?: The Association of Vitamin D with Injury Incidence among Acrobatics and Tumbling Athletes

Purpose: Acrobatics and Tumbling (A&T) is an emerging NCAA sport. Due to the novelty of the sport, limited research on injury incidence and correlates exists. Anecdotal evidence suggests that A&T presents with high injury rates. A relationship between vitamin D and bony injuries exists among athletes, but little is known about soft tissue injuries. Understanding the causes and incidence of injuries, including vitamin D, may assist athletic trainers. Methods: Forty-two A&T athletes (19.69 ± 1.199 years) completed 2 blood draws as part of routine medical care prior to and following fall training period. Results: Average vitamin D at T1 was 47.976 ± 18.874 ng/ml and T2 was 41.883 ± 18.453 ng/ml. Injury variables (i.e., incidence, mechanism) and time loss (TL) were recorded between blood draws. T-tests and ANOVAs assessed differences in injuries and TL based on serum vitamin D. Poisson and logistic regressions were utilized to assess injury and TL odds ratios based on vitamin D. Twenty-eight injuries were sustained and eleven participants suffered TL. Serum vitamin D significantly decreased an average of 6.093 ± 10.973 ng/ml (pConclusions: No significant differences in injury status or TL based on vitamin D were identified. Identifiable patterns were found in injuries sustained by participants. Serum vitamin D concentrations showed a significant decrease as volume and intensity of training increased. The significant decrease in vitamin D and high injury incidence indicates a need for further monitoring of biomarkers, such as vitamin D, in these athletes and research to determine injury prevention strategies.

Student Perspectives on Transition from Bachelor’s to Master’s Degree for Professional Athletic Trainers: Advantages and Disadvantages

Purpose: The purpose of this study is to understand the perspectives of students interested in a career in athletic training on the degree change and what they perceive as advantages and disadvantages to pursuing a master's level professional degree in athletic training. Method: A case study was conducted using an interpretivism framework informed by a constructionism theoretical stance. A focus group of six current undergraduate pre-athletic training students and individual interviews of three pre-athletic training graduates along with current and historical documents were used to collect data. An inductive approach was used to analyze data along with reflexive thematic analysis to extract the advantages and disadvantages of the degree change from the students’ perspectives. Results: Several advantages and disadvantages to the degree change were identified by participants. Advantages outnumbered disadvantages in all three data sources. The top three advantages to the professional degree change were advanced knowledge and education, increased trust in ATs, and more respect and recognition for the profession. The top three disadvantages to the professional degree change were cost of additional school, limited locations/distance to schools, and academic challenges. Conclusions: This study found that the mandated professional degree change in athletic training education has more advantages than disadvantages according to students interested in pursuing a career in athletic training. With stakeholder knowledge of these student perspectives, institutions and master’s level professional ATPs may be better prepared to implement to assist future students in overcoming barriers and potentially increase enrollment and prevent an AT shortage in the future.

Effect of Russian Current and Structured Exercise Program on Postpartum Diastasis Recti Abdominis: A Case Series

Background: Diastasis recti abdominis (DRA) is the most common complication occurring post-delivery that limits the functional well-being of the affected individuals. Management of diastasis recti can include an abdominal binder, core strengthening, taping, and various surgical procedures. There is limited evidence to support the Russian current and structured exercise intervention in managing patients with DRA. Methodology: Three patients identified with DRA underwent a multi-modal treatment regimen including a hot moist pack, Russian current, abdominal binder, transverse abdominus activation exercises, treadmill training, and stationary cycling training. Outcomes were assessed using the visual analogue scale, abdominal girth, Ranney DRA scale, Oswestry low back disability questionnaire, and McGill’s torso battery test. These measures were administered at baseline and discharge. Results: Each patient demonstrated improvements in all outcome measures. The visual analogue scale improved by a mean of 7.3 on a 0–10 point scale, DRA reduced to 1 finger and the Oswestry disability questionnaire showed no disability. Conclusion: Structured exercises and Russian current were effective in managing three patients with DRA. The inclusion of Russian current and structured exercise within this multi-modal approach may enhance the conservative management of patients with DRA.

Promoting Cultural Humility as a Core Value into Healthcare Professional Practice: Focusing on the Journey and not the Destination

There is an increase in diversity in our nation, and as such, health care professionals need to have the tools to maximize patient outcomes, considering the breadth of these needs. It is important to improve effectiveness, as health care providers, by increasing cultural awareness and knowledge of cultural humility. The three factors that guide cultural humility include lifelong commitment to self-evaluation, fixing power imbalances, and developing partnerships with people and groups who advocate for others. These aspects may enhance future health care providers’ ability to minimize health care disparities and optimize health care for all patients. In addition, discussions related to cultural humility may contribute to a lifelong commitment to self-evaluation.

The Art of Empathy: Visual Art Interpretation and Creation to Enhance Empathy in DPT Students

Purpose: To pilot the inclusion of a visual arts unit grounded in social constructivist theory and framed around Visual Thinking Strategy into an entry-level anatomy course and explore its influence on enhancing empathy in Doctor of Physical Therapy students. Methods: 37 students enrolled in the second semester of an 8-semester program participated in this exploratory study using a mixed methods, pre-test, post-test design. Prior to and after the 3-week unit, students completed the Jefferson Scale of Empathy – Health Care Provider Student version (JSP-HPS). After the unit, students provided written reflections on their learning experiences. The JSP-HPS was assessed via paired t-tests. Reflections were considered using an interpretive phenomenological analysis (IPA); reflections were read and data points were coded for emergent themes, connections, and constructs. Results: JSP-HPS scores increased from 115.7 to 120.4 (p=.002) indicating enhanced empathy. Pluralistic intellectual humility (PIH) emerged as the primary construct from the reflections. PIH included 4 themes of 1) Ambiguity tolerance, 2) Self-discovery, 3) Empathy, and 4) Collaboration. Conclusions: Art interpretation and creation were effective in enhancing students’ empathy; however, empathy emerged as one aspect of the construct of PIH. Once the 4 themes emerged, we intentionally ordered them as potential building blocks. Enhancing empathy - the way to connect to the emotions and experiences of another person - is going to be challenging without addressing other aspects of PIH including ambiguity tolerance and self-awareness. Educators should consider the use of art interpretation and creation as a way to strengthen these critical characteristics.

Is Digital Altruism the Same as Offline Altruism?: An Exploration of Strength-Based Determinants Among Generation Z during COVID-19 Pandemic

Digital altruism is a new form of altruism on social media platforms. Social media has been a vital tool for sharing and seeking information for day-to-day situations, enabling people to seek and render help. Engaging in helping behaviour could be purely out of altruism or can be traced back to their professional requirements. Social media platforms have brought out people’s altruistic side on multiple occasions. The present study looked at the altruism levels of Indian Generation-Z social media users and how it is influenced by the users’ strength-based determinants, i.e. empathy, compassion, social justice, optimism, social intelligence, and personality, compared to offline altruism. The altruism levels, both online and offline, and the strength-based determinants of 204 participants between the age group of 16-24 years were measured. A regression analysis was run to understand the nature of the relationship between the independent and dependent variables. The results indicated that certain strength-based determinants impacted the levels of digital altruism.

Development and Validity of the Student-Run Outpatient Physical Therapy Experience Survey: A Pilot Study

Purpose: The preparation of professionals who are culturally sensitive and provide patient centered care is an expected outcome of physical therapist education. A review of the literature revealed that patient experience and outcome data regarding physical therapy student-led clinics are lacking. The purpose of this pilot study was to develop a valid patient experience survey that assessed patient centeredness and cultural competence in a gender-neutral manner. Methods: Questions for a new survey, Student-run Outpatient Physical Therapy Experience Survey (SOPTES) were generated using two validated surveys, the Questionnaire of Patient’s Experiences in Post-Acute Outpatient Physical Therapy Settings (PEPAP-Q) and the Tucker-Culturally Sensitive Health Care Provider Inventory Patient Form. The SOPTES was implemented with the validated PEPAP-Q in a student-led clinic and given to 88 patients at discharge. Correlation and exploratory factor analysis were performed. Results: The correlations of patient scores between the two surveys, revealed a significant moderate correlation based on 2-tail analysis (ρ =.396, p < 0.001). Exploratory factor analysis revealed five themes for the PEPAP-Q (patient centered care, supportive environment, availability, invested interest, and adaptability) and three themes in the SOPTES (patient centered care, availability, cultural competence). Conclusion: These findings support the development and use of the SOPTES in a student-led physical therapy clinic to assess student cultural sensitivity and provision of patient centered care.

A Neuromuscular Training Program Performed on Foam is Accompanied by Improved Balance and Jump Height in Recreational Runners

Purpose: To assess balance, plyometric performance, and strength of recreational runners completing a neuromuscular training (NMT) program on a novel foam surface. Methods: After baseline testing, participants (n=14) completed 22-minute exercise sessions on foam twice weekly for eight weeks, and a post-training testing battery. Testing included lower quarter Y-balance test (LQYBT), dynamic leap and balance test (DLBT), squat jump and countermovement jump tests, and isometric strength testing of the foot and ankle via handheld dynamometry (HHD). Participants were asked to maintain their normal running routines throughout the study period and report any training missed due to injury. Results: Participants demonstrated significant (pConclusion: This study supports the use of progressive NMT on foam as a feasible intervention for recreational runners as all participants maintained typical running routines and reported no injuries. While further research is needed to directly inform possible effects of NMT on foam on injury risk and running performance, the improvements in single leg dynamic balance, lower body plyometric performance, and some indices of lower extremity strength in the present study suggest the efficacy of NMT performed on foam.

An Evaluation of a Student Allied Health Professions’ Social Prescribing Scheme

Purpose: Social prescribing is a core part of healthcare policy within the NHS and requires support and contributions from all healthcare professionals, including Allied Healthcare Professionals (AHPs). The well-established medical student-led social prescribing student champion scheme (SPSCS) has been expanded to include AHPs, and AHP champions were recruited to deliver peer-led activities focused on social prescribing. This article aimed to evaluate the impact of the scheme's expansion on AHP students. Method: Fourteen AHP champions ran 21 activities that reached 524 students. Those participating in the champion-led activities were asked to complete pre- and post-session surveys to capture the impact of the sessions on their awareness of, knowledge of, and confidence with clinically applying social prescribing. Participants also rated the opportunity for multi-disciplinary interaction and overall experience of the champion led activities. Results: It was found that participant’s post-session scores for awareness, understanding and confidence were higher than post-session scores. Further, post-session survey results showed that participants enjoyed and felt they had been able to experience multi-disciplinary interaction at events. Conclusions: In summary, the evaluation of the AHP SPSCS highlights the value of student-led peer teaching in helping to raise awareness and understanding about social prescribing for AHP students, whilst acknowledging the need to expand the scheme’s reach in the future.

Forward Thinking and Adaptability to Sustain and Advance IPECP in Healthcare Transformation Following the COVID-19 Pandemic

The proliferation of the novel SARS-CoV-2 (COVID-19) virus across the globe in 2020 produced a shared trauma internationally of unprecedented devastation, disruption, and death. At the same time, the pandemic has been a transformation catalyst accelerating the implementation and adoption of long overdue changes in healthcare education and practice, including telehealth and virtual learning. The COVID-19 pandemic has placed healthcare at a crossroads, either viewing it as a temporary situation that requires short-term solutions, or as a major disruption that presents opportunities for innovation for sustainable development and transformation. As COVID-19 transitions from pandemic to endemic, we have a unique opportunity to leverage lessons learned that can foster healthcare transformation through innovation, forward thinking, and interprofessional education and collaborative practice (IPECP). With the changing landscape of higher education and healthcare, IPECP leaders need to reflect on and implement ‘Forward Thinking and Adaptability’ and ‘Sustainability and Growth’ in their IPECP approaches and strategies to achieve the Quintuple Aim. To capitalize on this opportunity and based on a recent publication by <a Global, this paper explores and debates (from a global perspective) the impact and application of healthcare education and practice transformation on IPECP with the goal to identify best practices in integrating and sustaining IPECP and building a resilient workforce.

Influence of Personality on Ethical Decision-Making in Communication Sciences and Disorders

Purpose: A relationship between personality and ethical decision-making has been demonstrated in professions both within and outside of healthcare. However, this relationship has not been examined in the rehabilitation therapies, including speech-language pathology (SLP). Given the ethical dilemmas faced by therapists, it is important to assess this relationship and to modify ethical training when warranted. Methods: A total of 175 undergraduate communication sciences and disorders students participated in completing the Kiersey Temperament Sorter II and the Defining Issues Test-2. Scores were statistically compared to determine the relationship between the two assessments. Results: Based on a model of moral reasoning development, high scores on the DIT-2 are believed to correlate with post-conventional reasoning skills. Higher scores were statistically related to personality scores of strong introversion (I) and strong intuiting (N). Conclusion: Participants with strong introversion (I) and strong intuiting (N) traits may have natural skills for higher levels of moral reasoning. This implies that training modules for students and therapists should recognize personality differences and assist all individuals in developing best methods of problem solving in the face of specific personality traits.

A Model for Teaching Financial Literacy in a Doctor of Physical Therapy Program Using the Five Stages of Career Development

Purpose: The cost of higher education programs across allied health disciplines have increased substantially in recent years while salaries have remained relatively stagnant. The result of which is an increase in debt burden for graduates of allied health professional programs. One possible intervention to improve the experience of graduates is to improve financial literacy; however, research on the effectiveness of financial literacy education in higher education is scant. Therefore, the purpose of this study was to understand the effectiveness of a financial literacy and career planning seminar in a Doctor of Physical Therapy (DPT) program. Specifically, this study aimed to (1) describe the implementation of a novel career planning and financial literacy workshop as an additional component of a required physical therapy administration course in a DPT program, and to (2) understand the outcomes and effectiveness of the model utilized. Methods: This study included a single cohort pre/post design and between subject analysis. DPT students completed a pre- and post-survey before and after attending a 1-hour asynchronous career planning and financial literacy workshop. The survey included questions to capture students’ knowledge and confidence in financial literacy. Results: Overall, 80 DPT students completed the pre-survey and 54 DPT students completed the post-survey. The group of 55 participants that completed the post-workshop knowledge portion of the survey (M=87%, SD 220.72) demonstrated significantly better knowledge scores t(124) = 7.44, p < .05 compared to the group of 77 participants that completed the pre-workshop knowledge portion of the survey (M = 67%, SD 282.31). The group of 53 participants that completed the post-workshop confidence portion of the survey (M=35.79%, SD 27.09) demonstrated significantly improved confidence on the post-workshop survey t(130) = 2.75, p < .05 compared to the group of 79 participants that completed the pre-workshop confidence portion of the survey (M = 32.62, SD 64.57). Conclusion: A 1-hour workshop can be effective at improving knowledge and confidence in financial literacy of DPT students, and it can be implemented in existing DPT curricula without considerable time or added credit hours.

Stressed Fracture: The Relationship Between Coping Strategies and Workload in Secondary School Athletic Trainers

Purpose: The work environment for an athletic trainer (AT) working in a secondary school is typified by heavy workloads and job-related stress. Occupational stress can have negative effects on productivity, absenteeism, employee turnover, and quality of life. Research suggests that personal and situational factors can influence the coping process adopted by an individual. The approach-avoidance framework suggests that people cope with a stressor by either attempting to reduce it or removing oneself from that stressor. Previous research on other healthcare professionals suggested that use of avoidance coping was correlated with higher levels of job stress and those who perceived greater social support possessed lower work-related stress. However, the relationship between coping strategies and perceived social support has not been examined in ATs. The purpose of this study was to examine the relationship among coping strategies, perceived social support, and workload in secondary school ATs. Method: This was a cross-sectional study completed via an online survey. Three hundred, ninety-two (392) secondary school athletic trainers (35.7 ± 11.1 years old) from all NATA districts responded to the survey. Outcomes included the Brief COPE, Multidimensional Scale of Perceived Social Support, and average hours worked. Results: The average workload reported was 44.10 ± 12.96 hours a week over the school year (i.e., fall and spring). The regression model showed that avoidant coping (B=0.34, 95% CI=0.12, 0.56, p=.005) was directly associated with the average number of hours worked (adjusted R2=.07). Approach coping (B=-0.28, 95% CI=-0.43, -0.12, p=.007) was indirectly associated with the average numbers of hours worked. However, perceived social support did not display a significant association with any variable of interest. Conclusions: Our findings suggest that a relationship between average workload and coping strategies adopted by secondary school ATs may exist. Increased workloads were related to increases in avoidance coping strategies. Further research in this area is needed to determine how coping strategies affect patient care.

How Traits of Emotional Intelligence Affect Perceived Stress in Entry-Level Doctor of Occupational Therapy Students

Purpose: Students in an entry-level Doctor of Occupational Therapy (OTD) programs are subject to high levels of stress and emotional burnout. Effective management of stress impacts life satisfaction and academic performance. Emotional intelligence (EI) has been shown to relate to lower stress levels in allied health students. Despite this, little has been done to investigate the emotional demands of an occupational therapy education. Methods: Participants were a convenience sample of 51 entry-level Doctor of Occupational Therapy Students recruited from the Southwest and Midwest cohorts of an OTD program. The participants were surveyed approximately 30 days after beginning their semester curriculum. Participants included 43 females and 8 males (n=51) with an age range of 21-36 years old. The sample was composed of 18 first-year (OT1) students, 17 second-year (OT2), and 16 third-year (OT3) students. A cross-sectional survey design was used, and the Assessing Emotions Scale and the Perceived Stress Scale questionnaires were both used to gather self-reported data regarding emotional intelligence and perceived stress. Emotional intelligence was correlated with perceived stress scores using the Spearman Rho analysis on SPSS program 25. Additionally, Kruskal Wallis analysis was used to determine if PSS and EI scores were significantly related to the year in the program. Mann Whitney U analysis was used to determine if PSS and EI scores were significantly related to gender. Results: A significant moderate negative correlation was found in this sample between emotional intelligence and perceived stress (rs= -0.391 with p= 0.005). There were no other significant relationships between variables. Conclusion: These findings have applications for developing educational programming and curriculum that may help equip Doctor of Occupational Therapy Students with the skills they need to thrive in their future profession. Additionally, opportunities exist for OTD students to increase EI and improve stress management levels and improve overall wellness.

The Effectiveness of Student-Driven Pro Bono Physical Therapy Services on Self-Reported Outcomes of Community-Dwelling Adults with Musculoskeletal Conditions

Purpose: Student-driven pro bono clinics provide a profound clinical education experience for health professional students while serving members of the community. Currently, there is little research on how the pro-bono clinic impacts the community members involved. The purpose of this study was to examine outcomes following discharge from a pro bono clinic held through an entry-level physical therapy program. Methods: Forty-one volunteer community members, 19 males (M) (46.3%) and 22 females (F) (53.6%), participated in this study. Ages ranged from 20-90 years, with a mean age of 41(17) years. Each community member completed the Wong-Baker FACES Pain Rating Scale (WBFS), Patient Specific Functional Scale (PSFS), and 36-Item Short Form Health Survey Questionnaire (SF-36) during the initial evaluation and discharge sessions. Community members were seen for 60 minutes once per week for a total of 2-5 visits. Descriptive statistics, Wilcoxon Signed Rank test, and means of the pre-test data and the post-test data were performed. Results: Wilcoxon Signed Rank test revealed significance at Z=-4.37, pConclusion: Community members who participated in the student-driven pro bono clinic achieved statistically significant improvement in pain and physical function. In addition to the established benefit of experiential learning received by the student, our study supports a received benefit to the community member.

A Model for Professionalism Evaluation: Using the RISE Assessment Tool Across DPT Didactic and Integrated Clinical Education

Purpose: There are limited options for professionalism evaluation during short term clinical experiences in physical therapy education. The purpose of this report is to describe the development of a new assessment tool (RISE) [Respect for Others, Integrity & Compliance, Self-Awareness & Commitment to Development, and Engagement & Work Ethic] as part of a longitudinal professional development model in the DPT didactic curriculum (RISE-SA) and integrated clinical education (RISE-CI). Primary goals of the RISE were to clearly define evaluation criteria, offer quick formative feedback, promote communication between clinical and academic faculty, and create objective professionalism assessment criteria. Method: The RISE assessment tool serves as a key element of the USF professional development curriculum that bridges academic and clinical education. Throughout the curriculum students use the RISE to refine professional development plans based on self-assessment and feedback from academic faculty, professionalism coaches, and clinical instructors. Results: Approximately 250 students, 25 clinical instructors, and 10 professionalism coaches successfully implemented the RISE Tool as part of the educational model. Preliminary feedback from students, academic faculty, and clinical instructors (n = 21) indicated that the RISE is time-efficient, easy to use, and helpful in categorizing positive and negative professional behaviors. Conclusions: Clinical instructors appreciated the time-efficient digital platform application of the RISE (about 1 minute to complete during integrated clinical education). A shared framework for professionalism facilitated communication of professionalism expectations between academic faculty, clinical instructors, and students. Further research is needed to evaluate the potential usefulness of RISE for full-time clinical education and for remediation of professionalism lapses.

Hearing Loss as a Risk Factor for Cognitive Decline in the Elderly: A Rapid Review

Purpose: The aim of this rapid review was to identify and evaluate evidence exploring hearing loss as a risk factor for cognitive decline in the elderly population. Methods: A literature search was performed in three databases: CINAHL, Cochrane Central, and PubMed. The PRISMA template was used to record the search and selection process. Search criteria included older adults aged 65 and up with diagnosed or self-reported hearing loss and no previous diagnosis of dementia or Alzheimer’s disease. Participants were excluded if they had been diagnosed with dementia or tested for it before the study began. Hearing loss was categorized using the pure tone average (PTA): normal (/= 25-40 dB), and moderate to severe impairment (> 40 dB). Selected research studies were critically appraised using the JBI checklist. A custom data extraction form was used to record inclusion/exclusion criteria, PICO data elements, risk of bias, and level of evidence. Results: Three longitudinal cohort studies met the inclusion criteria. The Joanna Briggs Institute evidence hierarchy was used to rate the level and quality of the studies. Results of the rapid review indicate the quality of studies a high or moderately high. A summary of the results for each study is provided. Clinical Implications: This review contributes to the growing body of literature suggesting that untreated hearing loss is a risk for cognitive decline. While there are various hypotheses on whether there is a definitive relationship between the two, many of the studies reviewed found that a hearing loss in older adults will result in a poorer change of cognitive ability or cognitive decline. Any patient aged 65 years or more indicating concern about hearing loss should be referred to an audiologist for a comprehensive hearing evaluation.

Title: Assessment of Student Perception Regarding Clinical Training in Undergraduate Dental Programs Using Clin Ed IQ.

Purpose. Clinical training is essential part of the dental curriculum. Both clinical environment and Teachers are essential factors which affect the acquired clinical skills. The objective was to assess the perceptions of dental students regarding their clinical training. Methods. This mixed method study using Clin Ed IQ questionnaire was conducted on Dental students graduating from both Private and Public sector institutes of Karachi. The questionnaire had four sections, the first three based on various aspect of clinical training, with responses based on 5-point Likert scale. Section four had open-ended items about dental curriculum. Results. For responses of 220 participants related to the first three sections, mean and standard deviation was calculated. Section two about Involvement in specific learning activities, had the lowest composite mean score (8.4). Results for all responses of agreement were tabulated as percentages. Overall, the scores were positive, with Section three regarding interaction with clinical instructors having highest positive responses. Dental graduates of Private sector institutes were more satisfied by their clinical training. Thematic analysis of open-ended questions yielded themes related to trained faculty, communication skills, patient safety skills, diversity, and integrated curriculum. Conclusion. The students of both types of institutes reported lack of diversity in clinical cases and deficient feedback from instructors as their major concern. However, the results showed a positive perception to their clinical experiences. Institutes and regulatory authorities should address areas of concern, to ensure provision of a holistic clinical learning environment to dental graduates.

Utilization of the Canadian Interprofessional Health Collaborative as an Evaluation Framework for Student Participation in a Community-Engaged Project

Purpose: Interprofessional education is a foundational component of many health professions educational programs as it contributes to the goals of the Quadruple Aim by prioritizing collaborative and streamlined quality healthcare. Furthermore, student engagement in interprofessional educational activities provides opportunities to better understand their own and others’ health profession disciplines. The purpose of this project was to utilize Canadian Interprofessional Health Collaborative (CIHC) to evaluate a framework for student engagement in a community-engaged project focused on reducing barriers to care in people living with type 1 diabetes in rural communities. Methods: As members of an interprofessional, type 1 diabetes, community-engaged research team, students from various graduate and pre-health professions programs participated a variety of activities as research assistants to increase their competency as future healthcare practitioners. These activities included research capacity building, interprofessional collaborations, patient and community interactions, and interprofessional healthcare research. Utilizing the CIHC Framework, the learners reflected and assessed their interprofessional competency, growth, professional identify, and understanding of interprofessional collaboration while providing suggestions for future students participating in interprofessional health sciences research. Findings: Learners found the CIHC to be a robust tool for reflecting on their abilities to provide care in an interprofessional team. The community engagement projects heightened their abilities in role clarification, team functioning, and collaborative leadership which were determined by the group to be some of the most essential skills for entering an interprofessional healthcare workforce. Conclusions: Use of the CIHC framework was an effective method to guide learner progress in developing interprofessional skills within a community engagement project. Reflection on achievement of CIHC domains assists learners in identification of growth in professional identity and understanding of interprofessional collaboration.

Perceptions of Incivility Among Students and Faculty in Entry-Level Health Professional Programs

Purpose: Online education is growing in popularity but has the potential to result in cyber incivility leading to disruptions in the learning environment. There is little known about the differences in attitudes between students and faculty in the online learning experience regarding cyber civility. The purpose of this study was to analytically measure student and faculty perceptions and attitudes of cyber incivility. Methods: A convenience sample of 180 (34 faculty and 146 students) participants from a health care university were recruited. A 27-item survey was given to record the perceptions of students and faculty on issues of cyber civility. An exploratory factor analysis was completed to validate the survey tool and determine the factors that made up the survey. A Mann Whitney U test was conducted to determine significant differences between student and faculty perceptions on the survey items. Results: Four factors were identified of the retained 19 items after the exploratory factor analysis: attitudes, presentation, appearance, and multitasking. There was a significant difference on 10 of the remaining survey items between students and faculty. Conclusions: Faculty perceived unprofessional dress, multitasking, and active display of complaints in the virtual environment more uncivil and disruptive than students. The themes show the differences between students and faculty perceptions in online platforms in healthcare educational programs. These differences highlight the need for healthcare educational programs to focus on strategies that align student and faculty expectations to positively impact the dynamics of the class and enhance learning in the virtual environment.

Student Athletic Therapists' Knowledge of Pain-Relieving Medications: A Nationwide Study

Purpose: Misuse of pain-relieving medications (PRMs), including opioids, is high among injured athletes. Athletes are increasingly relying on PRMs and as a result, it is likely that student athletic therapists (SATs) have managed athletes who have misused PRMs and may have potentially missed important symptoms placing athletes in harm. While dispensing PRMs is not within the scope of practice of the SAT, recognition and referral are. Previous research has found that SATs feel ill prepared to recognize PRM misuse and feel tremendous pressure to provide correct health information to the athlete. The purpose of this study was to expand on previous pilot work and uncover SATs knowledge on PRMs nationally. Method: A survey was sent to SATs currently studying in accredited Athletic Therapy programs and recent graduates (AATP). Results: A total of 57 surveys were completed. Results indicated that SATs believed they lacked sufficient knowledge related to PRMs and opioids however their personal knowledge of PRMs and opioids empowered them to provide athlete education on such medications. Over half of the SATs indicated that they have been approached by athletes and coaches to provide PRMs. SATs reported experiencing considerable pressure to provide athletes with correct information and showed stigma towards athletes misusing opioids. Conclusions: Although SATs reported the ability to recognize an athlete misusing opioids, they were unsure of how to make a quick decision when faced with potential opioid misuse situations. Recommendations: We recommend that curriculum, as well as clinical educators, address the pressure SATs experience and reinforce education to help identify and manage athletes who potentially misuse PRMs. Our study provides insight into the current level of knowledge of Canadian SATs regarding PRMs and opioids to help educators and others who work with SATs in a field setting.

Effect of Action Observation Therapy on Pain, Kinesiophobia, Function, and Quality of Life in Adhesive Capsulitis Patients

Background: Adhesive capsulitis is a common musculoskeletal health problem. Cortical changes along with maladaptive pain behavior has been reported in literature. There is a need to implement biopsychosocial rehabilitation approaches to achieve successful outcomes. Hence, this study aims to evaluate the effect of action observation therapy (AOT) on pain, kinesiophobia, function and quality of life in adhesive capsulitis patients. Methods: This single-center, prospective study was conducted in a group of 30 persons diagnosed with adhesive capsulitis patients (19 males, 11 females). Patients were randomly assigned into two groups. Patients in one group were given AOT along with conventional exercises, while the patients in the other group received only conventional exercises. The patients were evaluated before and after 4 weeks of intervention using numerical pain rating scale (NRS), pain catastrophizing scale (PCS), Tampa scale of kinesiophobia (TSK), Shoulder pain and disability index (SPADI) and 36-Item Short Form Survey (SF-36). Results: There was a statistically significant difference seen in pre and post intervention scores of the NRS, PCS, TSK, SPADI, SF-36 PCS and SF36 MCS (p0.05). Conclusion: The present study supports the addition of AOT to conventional exercises in rehabilitation of patients with adhesive capsulitis. AOT promotes a top-down approach leading to cortical reorganization and helps to reduce kinesiophobia and improve quality of life in adhesive capsulitis patients as compared to conventional exercises alone.

Student Perceptions of Reading Preparation and Textbook Use in Professional Allied Health Programs

Purpose: In professional allied health education, textbooks are central to developing course content, student learning and certification exams, but little is known about the graduate student’s perspective. This study was intended to describe current trends in graduate students’ point of view, habits and opinions related to buying and using textbooks and other resources in allied health education. Methods: This was a multi-site collaborative research project. An electronic survey was developed to gather data on student habits and perspectives regarding textbook preferences including digital texts, academic reading, exam preparation, and obtaining course materials. The survey was distributed across four academic institutions. Of the 247 total surveys distributed, 222 participants completed the survey resulting in a 90% usable response rate. Students were in occupational therapy (n=186), physical therapy (n=24), and speech-language pathology (n=12) programs. The investigators used descriptive statistics to analyze quantitative items and concept coding for three open-ended items. Results: The majority of students (74.2%) reported that they purchased required textbooks and a similar 73.9% reported owning their text books; most of these students also kept the textbooks after the class completed. Funding for textbooks came from personal or family funds 88.4% of the time with few students having scholarship or other funds to pay for books. However, students were inconsistent in using textbooks to complete required reading with only 13.6% consistently completing readings before class and only 33.3% completed readings before an exam; 14.9% rarely completed the readings before an exam. Financial concerns, time constraints, and faculty support of textbook use were cited by students as influencing their buying and using textbook decisions. Despite evidence that digital textbooks may be less expensive, the majority of the students (76.0%) reported they would prefer to permanently own required textbooks and 86.9% preferred printed over digital textbooks. Conclusions: Allied health educators are encouraged to consider evidence-based pedagogical practices to reinforce textbook use and the use of technology to foster successful engagement in the classroom and in preparation for professional certification examinations.

The Use of Dynamic 3D Printed Cervical Spine Models in a Musculoskeletal Physical Therapy Course

Purpose: While mass-produced anatomical models are commercially available, many models are inflexible and static, and may not meet the needs of health professions students. Advances in three-dimensional (3D) printing have demonstrated tremendous potential for enhancing student learning. This study uses 3D printed cervical spine models to explore whether use of dynamic, flexible models improve student learning in a cohort of physical therapy students. Methods: 3D printed models of the cervical spine and occiput were printed using a fused deposition modeling 3D printer and polylactic acid filament, and augmented with hook and loop fasteners, foam sheets, and cords to simulate structures such as ligaments, intervertebral discs, and the spinal cord. Twenty-one second-year students enrolled in a Doctor of Physical Therapy musculoskeletal course were divided into two groups: one group had access to the augmented 3D printed models (n=11) and the other had access to commercially available models (n=10). A 10-question multiple-choice assessment was given on the cervical spine and its arthrokinematics before and after lectures and manipulation of cervical spine models. Four Likert-scale questions measuring confidence in explaining or performing a particular cervical spine movement and palpating bony landmarks were also queried. Results: There were no significant differences in the post-test scores for the dynamic and static model groups (t=.66, df=19, p=0.52), or in the confidence in explaining cervical spine movements when comparing the type of model used. Conclusions: This study did not replicate others’ findings of the effectiveness of dynamic 3D printed models. Factors may include that the length of time students manipulated models was unknown, that other studies compared 3D printed models and non-3D printed models (cadaveric donors, plastinated models, 2D images), and that 3D printing is not as effective for all anatomical regions. Despite the lack of significant differences, use of dynamic 3D printed models did not hinder learning and may complement other resources available in physical therapy educational settings.

The Effectiveness of Serotonin and Tricyclic Antidepressants in Tinnitus Management: A Rapid Review

Background: Tinnitus can be defined as a health condition characterized by the perception of sound, either in the head and/or ears, in the absence of any external acoustic stimulus. Perception is often quantified by self-report, or the use of patient reported outcome measures (PROMs). The purpose of this rapid review was to evaluate the level and quality of evidence regarding the use of serotonin and norepinephrine reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI), and tricyclic antidepressants as measured by tinnitus patient-reported outcome measures (PROMs) and/or Visual Analog Scales (VAS). Methods: The Cochrane Rapid Review guidelines were followed. The PICO mnemonic was used to “frame” the research question. The search strategy was developed and executed in three databases: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Inclusion and exclusion criteria were established a priori. The search, identification, and selection process were plotted using the PRISMA Flow Diagram. Results were extracted to a custom form. Critical appraisal and risk of bias assessments were completed using standard critical appraisal tools. Results: Three hundred and seventy-five publications were identified and deduplicated, 286 were screened, 266 were deemed irrelevant. Twenty publications were identified for full text review. Seven randomized controlled trials (RCT) met the inclusion criteria and were assessed for design, quality, and bias. The level and quality of the RCT studies included were rated. Statistically significant benefits for amitriptyline, nortriptyline, fluoxetine with alprazolam, and sertraline were reported for tinnitus sufferers whereas fluoxetine alone, trazodone, vestipitant or vestipitant with paroxetine, or paroxetine alone did not demonstrate significant results. A meta-analysis was not completed due to the heterogeneity of studies. Conclusions: Despite promising results, there remains insufficient rigorous high-quality research evidence to indicate that antidepressants can effectively treat subjective tinnitus at this time.

Effect of Posterior Leaf Spring and Carbon Composite Ankle Foot Orthosis on Gait and Functional Mobility of Stroke Survivors with Hemiplegia: A Randomized Clinical Trial

Purpose: The study was carried out as a randomized clinical trial to assess the effect of posterior leaf spring ankle foot orthosis (PLS-AFO) and carbon composite ankle foot orthosis (C-AFO) on functional mobility, walking speed and satisfaction among stroke survivors with hemiplegia. Methods: Twenty-seven ambulatory stroke survivors with hemiplegia who had completed a rehabilitation program and were already using an ankle foot orthosis (AFO) were included in the study. Subjects were randomly assigned either PLS-AFO or C-AFO and assessment was done with and without their AFOs. Functional mobility, walking speed, and satisfaction were assessed using the Timed Up and Go test, the 10-meters walking test and the Client Satisfaction with Device questionnaire, respectively. Results: Both types of AFO improved functional mobility. C-AFO and PLS-AFO reduced Timed Up and Go test time by 7 seconds (22.4%), and 4.4 seconds (10.5%) respectively. Self-selected walking speed increased in AFO users by 0.20 m/s (40%) and 0.10 m/s (33.3%) for C-AFO and PLS-AFO, respectively. No changes were observed during the fast-walking speed. With both AFOs, participants were satisfied in terms of weight, fit and comfort (>90%). Conclusion: It is concluded that both PLS-AFO and C-AFO can improve the walking ability of stroke survivors with hemiplegia. C-AFO demonstrated better self-selected walking speed and functional mobility as compared to PLS-AFO. Neither of the AFOs improved the fast-walking speed. Both AFOs provided a high level of user satisfaction.

Allied Health Professions in Research: The Forgotten Workforce

Purpose: To understand the experience, involvement, and perceived importance of research among allied health professions and identify how robust research culture might be established in secondary care. Method: Analyses were carried out on quantitative and qualitative data using an online questionnaire disseminated to allied health professionals working in a national health service trust in the north of England. Logistic regression was used to ascertain whether Agenda for Change banding and profession significantly influenced research qualifications, experience, and interest. Qualitative data was analysed within a theoretical framework that focused on, career development, job satisfaction and clinical practice. Results: Educational attainment, research experience and interest were significantly greater among allied health professionals in higher Agenda for Change bands. Conclusions: Involvement in research provides allied health professionals opportunities for career development, job satisfaction and meaningful clinical impact. National Health Service Trusts should provide infrastructure to support research activity in recognition of their skills and potential to increase research capacity for the benefit of patients.

Occurrence of Temporomandibular Disorder in Subjects with Low Back Pain and Spinal Postural Deformities: An Observational Study

Purpose: Back pain and temporomandibular disorder (TMD) are two predominant illnesses that affect the human motor system. Literature has stated significant associations between chronic low back pain (CLBP) and TMD. Global postural deviations cause body adaptation and realignment, which may interfere with the function of TMJ. However, the possibility of TMD in subjects with CLBP associated with spinal postural deformities has yet to be completely explored. Method: This was an observational study carried out among 65 people having CLBP with co-presence of any spinal deformities. Forward head posture (FHP) was assessed using the On-Protractor application and thoracic kyphosis and lumbar lordosis were assessed using flexicurve. Those with co-occurrence of LBP and spinal deformity were further evaluated for the presence of TMD using Fonseca’s questionnaire. The prevalence of TMD in LBP along with spinal deformities was analyzed and the variables were compared based on gender, age categories, and type of LBP (specific and non-specific). Results: The overall prevalence of TMD (mild, moderate, and severe) was 89.2% (n=58) in participants with low back pain and spinal postural abnormalities. The severity of FHP was more in specific LBP than in non-specific LBP, while the occurrence of TMD was equal. The severity of TMD was higher in females than males. Conclusion: The occurrence of TMD is highly prevalent in patients with low back pain and spinal postural deformities. The findings of the study imply that individuals with low back pain and spinal postural deformity should also be evaluated for TMJ dysfunction and initiate early intervention.

Gross Motor Assessment Tools for Children 0-12 Years of Age Using Telehealth: A Scoping Review

Objective: The objective of this review was to understand the scope of evidence relating to the use of telehealth for gross motor assessment tools in children 0-12 years of age.

Background: Telehealth has been widely used by physiotherapists since the start of the Covid-19 pandemic, however little is known about the validity and reliability of using gross motor assessment tools via telehealth. Gross motor assessment tools are used by physiotherapists to understand motor function, support diagnoses of motor disorders, plan and evaluate interventions. Qualitative research identifies a lack of confidence by physiotherapists in undertaking physical assessment via telehealth.

Method: A comprehensive search was undertaken of MEDLINE, Scopus, CINAHL, Physiotherapy Evidence Database (PEDro) and OTseeker in August 2022. Grey searching was also implemented. Two independent reviewers identified articles for inclusion and critically appraised the articles. Data was analysed using a narrative review.

Results: 34 studies met the inclusion criteria.

Factors Affecting the Use of Vestibular/Balance Screening Measures in Audiologists and Physical Therapists in Patients Reporting Dizziness

Purpose: Vestibular/balance screeners can improve the efficiency of the diagnostic process. Despite prior literature illustrating the importance of screeners, research suggests that many professionals do not utilize screening protocols. Methods: Thirty-two audiologists and thirty-four physical therapists completed an electronic survey with questions regarding the use of screeners and the referral process. The survey examined variables surrounding the use of vestibular/balance screeners among audiologists and physical therapists, including frequency of use, commonly used screeners, and factors affecting the use or non-use of screeners. Results: Physical therapists utilized vestibular/balance screeners statistically more often and used a larger variety of screeners compared to audiologists. The most commonly reported factors for not using screeners were lack of time, training, and reimbursement. Conclusions: This study highlights the importance of screener training for both audiologists and physical therapists. With increased interdisciplinary interaction and screener use, accurate diagnoses and referrals can be made sooner in order to create treatment plans for patients with vestibular/balance disorders.

The Ventilatory Management of Paediatric Central Sleep Apnoea: A Systematic Review

Purpose: Paediatric central sleep apnoea (CSA) occurs more frequently in the presence of another medical condition. This systematic review aimed to determine the effectiveness of oxygen therapy and non-invasive ventilation (NIV) for children with CSA and additional underlying comorbidities. Method: A search was undertaken of CINAHL Complete, Emcare, Scopus, MEDLINE, and PubMed with forward and backward citations for studies published between database inception and the 5th of May 2022. Articles of any study design or quality were included, excluding systematic reviews, letters, or study protocols. Articles had to involve only paediatric patients with a diagnosis of CSA with another underlying pathology and incorporate a detailed treatment protocol involving oxygen therapy or NIV to be eligible for inclusion. Relevant articles selected for the review were thoroughly analysed and appraised using the Crowe Critical Appraisal Tool. Using the Synthesis Without Meta-analysis (SWiM) reporting guideline, a narrative synthesis was utilised due to heterogeneity in the populations, interventions, outcomes, and designs of included studies. Results: Of 3295 identified articles, 13 were eligible, with critical appraisal detecting common weaknesses in the areas of ethical matters, results, and discussion sections of articles (mean total score of 69%). Nocturnal oxygen therapy and NIV positively impacted polysomnography results. A wide range of underlying diagnoses were associated with CSA, however, definitive conclusions surrounding the interventions’ effectiveness and applicability to specific presentations could not be drawn. Conclusions: Research quality was generally poor, with studies’ external validity, strengths/limitations, and suggestions for future research rarely described. The presence of reporting bias and a lack of analysis, integration, and interpretation methods were also limitations. Future research should include larger samples through the organisation of multi-centred trials to increase the generalisability and validity of the results. The impact of patient adherence to interventions should also be explored.

Trends in Length of Stay: Experience From a Tertiary Care Pediatric Rehabilitation Unit in Saudi Arabia.

Background: Pediatric rehabilitation units offer unique challenges due to complex rehabilitation needs of children based on their age group and diagnosis. Length of stay (LOS) is an indirect measure of hospital cost and efficiency of a clinical service and it is important to determine the factors affecting LOS in hospitalized children undergoing inpatient rehabilitation. Methods: Record of 350 children (males: 222, female: 128) who underwent inpatient pediatric rehabilitation program at King Fahad Medical City, Riyadh Saudi Arabia during 2011 to 2018 were reviewed. Diagnoses were categorized into cerebral palsy, spinal cord injury, traumatic brain injury, non-traumatic brain injury and others. Variables such as age, gender, diagnosis, home location, and length of hospital stay were analyzed. Median (25th – 75th quartiles) are reported for non-normally distributed quantitative variables. Results: Most children admitted for rehabilitation had diagnoses of cerebral palsy (40%) and traumatic brain injury (22%). The median LOS was 39.5 (28.75 – 56) days, patients with spinal cord injuries had a significantly higher LOS 46 (30 – 72) days. Two-thirds of the children were from outside the Riyadh region. Cerebral palsy patients were significantly younger in age 6 (5 – 9) years as compared to other diagnoses. Traumatic brain injury was prevalent significantly in males (p=0.018), whereas female patients had a significantly higher non-traumatic brain injury (p=0.018). Spearman Rho Correlation results depicted a weak but significant positive relationship between LOS and age (rho=0.142, p=0.018). Conclusion: LOS of children undergoing inpatient rehabilitation varies according to the diagnosis, age, gender, and home location. LOS may be reduced by adapting strategies based on these measures.

Effects of a Multi-Modal Gait Training Program in an Individual with Chronic Stroke: a Case Study

Purpose: Multi-modal gait training (MMGT) may improve impairments and functional limitations in individuals’ post-stroke. The purpose of this case study was to investigate effects of MMGT on gait and balance outcomes immediately post-intervention, 30-day short term (ST) and 1-year long term follow-up periods. Method: A 63-year-old patient, eight years post-stroke, participated in a MMGT program that included evidence-based gait interventions: unilateral treadmill training, inclined treadmill training at 8%, and over-ground fast walking. The eight sessions lasted 45-minutes each and consisted of the three interventions lasting 10-minutes each with rest breaks. Results: Self-selected (SS) and fastest comfortable gait speed revealed meaningful changes (post-intervention, however, only SS gait speed maintained improvements at ST measurements). The Activities Balance Confidence Scale (ABC) increased from 19% to 28% at 1-year. Conclusions: MMGT is soundly grounded in the contemporary principles of neuroplasticity. This case study confirmed that the combination of three task-specific and intense gait training interventions are safe and feasible for persons in the chronic phase of stroke. While ST results showed this MMGT improved all study outcomes from baseline to immediate post-intervention, substantial gains were retained only for SS gait speed and ABC scale at the 1-year follow-up.

Healthcare Experience Impact on First-year Physician Assistant Students’ Communication Self-efficacy

Purpose: Healthcare experience (HCE) is required by most physician assistant (PA) programs for application, but it is not known what role HCE might play in the success of PA students. Communication skills are an important trait for a successful clinician, and previous HCE might lead to an improved ability to communicate with patients. This study examined the relationship between PA students’ healthcare experience (HCE) and their communication self-efficacy (SE). Methods: First-year PA students from Michigan PA programs were eligible to participate in an anonymous electronic survey. A previously validated survey to assess communication SE was used. HCE was assigned into 3 broad categories based on required training/education. Communication SE scores were compared for each program. Correlation between communication SE and HCE type and hours were analyzed.

Results: There was a 44% response rate (N=117). The most reported type of HCE was medical assistant (23.9%) and nursing assistant (31.6%). There was no difference in communication SE scores between PA schools (p=0.394). There was no correlation between communication SE and total HCE hours (p=0.367), type of training/education for HCE job (p=0.577), and the number of weeks of training/education (p=0.384). Conclusion: There was no correlation between the type of HCE and communication SE in first-year PA students. It is possible varying types or amounts of HCE could result in greater preparedness for PA school by improving traits outside of communication ability.

Self-Care Strategies of Athletic Trainers

Purpose: Strategies for reducing burnout and improving work-life balance have been recommended for both organizations and individual athletic trainers. Little is known about what types of self-care (SC) strategies are already being used by athletic trainers. The purpose of this study was to explore and describe the number and type of SC strategies used by athletic trainers on a weekly basis. Methods: We used a cross-sectional design with web-based survey to explore the SC strategies used by athletic trainers. The survey instrument consisted of a SC checklist which asked the participants to select all the SC strategies they engage in weekly with 17 potential options, including an opportunity to describe intensity of exercise and also an “other” option with the ability to describe additional strategies. Results: Participants were mostly female, in their mid-career (age = 33 ± 9 y; experience = 10 ± 8 y), predominantly White, working in the college/university setting, holding a professional master’s degree. Participants engage in 6.9±2.8 SC strategies per week (range=1-15; mode=6). They most often engage in positive social relationships (n=522, 72.5%), humor (n=477, 66.3%), laughter (n=476, 66.1%), hydration (n=472, 65.6%), and moderate exercise (n=418, 58.1%). Participants most often selected physical (2.6±1.1; range=1- 4; mode=3, n=681, 94.6%), interpersonal (2.6±1.0; range=1-3; mode=3, n=665, 92.4%) or contemplative and meditative (2.1±1.3; range=1-5; mode=1, n=641, 89.0%) SC strategies to use on a weekly basis. Creative strategies were used the least frequently (1.0±0.2; mode=1, n=341, 47.4%). Only 25 (3.5%) participants indicated they engaged in no SC strategies weekly. There were no statistically or clinically significant differences between groups of gender identities or early and late career athletic trainers when compared to weekly use of contemplative and meditative, physical, interpersonal or creative SC strategies. Conclusions: Physical and interpersonal SC strategies are most popular among athletic trainers. Athletic trainers should continue to engage in SC strategies, as wellbeing positively impacts connections to the workplace. Organizations should implement workplace wellness and employee assistance programs that embrace common SC strategies.

Beyond Employment: Lower Income Participants' Experiences in a Healthcare Training Program for Medical Assistants, Pharmacy Technicians, and Certified Nursing Assistants

Purpose: The purpose of this study was to gain a deeper understanding of participant experiences in a healthcare training program for medical assistants, pharmacy technicians, and certified nursing assistants in areas beyond employment procurement or retention. During the year 2020, employment rates decreased and the cost of living increased. Those changes ultimately put lower-income populations at risk for not meeting the basic needs of life, as it became increasingly more difficult to obtain an adequately paying job. Healthcare training programs for lower income individuals allow for participants to gain the appropriate knowledge and experience required for working in the healthcare industry while also providing them necessary skills and confidence for securing and maintaining employment. While the primary objective of the Genesis Center Healthcare Training Program was to increase employment rates, this study found the program substantially contributed to participant’s lives in many ways that will contribute to their overall life satisfaction, financial well-being, and mental wellness for many years. Method: This current research adds to existing literature by utilizing a mixed methods sequential exploratory strategy that analyzes quantitative survey data (n=51) and qualitative data from phone interviews with program participants (n=19). Results: Findings from this study provide evidence that healthcare training programs for lower income populations may improve participant lives by increasing financial well-being and financial capability. Participants also reported enhanced opportunities, increased motivation, and improved mental health following participation. Conclusion: Employment programs for future allied health professionals targeting lower income populations should ensure that financial coaching and additional supports are included in their protocols. Future research on these types of training programs should include pre/post measures and ideally experimental design procedures using standardized measures for life satisfaction, financial well-being, and mental health.

Perceptions, Practices, and Barriers of Athletic Trainers in the Military Setting Using Patient-Reported Outcomes in Practice

Purpose: The majority of athletic trainers (ATs) recognize the importance of patient-reported outcomes (PROs) in clinical practice but encounter unique barriers that limit their implementation. There are no studies that have investigated PROs in the military setting. The purpose of this study was to explore the perceptions, practices, and barriers to implementing PROs in the military setting. Methods: We used a cross-sectional, web-based survey design. Emails were sent to 365 potential participants and 67 were eligible to participate (response rate=18.4%, years practicing in military setting=5.9 ± 5.8years). Participants were invited to complete a web-based survey regarding the uses, benefits, and problems with PROs. Dependent variables for all participants were endorsements of perception, practice, and barrier statements with PROs. ATs who reported using PROs in clinical practice were asked the criteria they use for selecting the measures, whereas ATs who reported not using PROs were asked their reasons for not using them. Results: Most ATs in the military setting reported not using PROs (59.6%, n=31/52). The most commonly cited reason for using PROs was documenting the status, progress, or outcomes of patients (41/52, 78.8%). Improving communication with the patient (54/57, 94.7%) was the most frequently endorsed benefit of PROs, while time for patients to complete (28/54, 51.9%) was the most common problem. The ease of understanding for patients was the most common criterion used to select individual measures (17/21, 81.0%). The most frequent reason for not using PROs were time for patients to complete and lack of a support structure (13/31, 41.9%). Conclusions: Less than half of ATs in the military setting use PROs in their clinical practice. Further research should investigate the mindset, motivation, and methods necessary for implementation to develop successful strategies for widespread implementation of PROs across practice settings in AT.

Second Victim Syndrome and Organizational Support for Healthcare Providers: A Scoping Review

Purpose: Healthcare providers may experience critical incidents, medical errors, or other adverse patient events in their clinical practice.Providers that encounter such events can experience second victim syndrome (SVS), a condition where providers feel psychological, cognitive, or physical reactions rendering care in these instances. Organizational support may mediate the impacts of SVS after an adverse patient event. We conducted a scoping review to explore and synthesize the literature on the support strategies implemented by healthcare organizations for healthcare providers after adverse patient events. Methods: The initial search strategy yielded 244 articles, 84 of which were removed for duplication. The 3-person review team completed title and abstract screening, reference screening, and full-text review, reaching 2-person consensus for article inclusion at each phase. To be included in analysis, studies had to be conducted in the United States, include real or perceived outcomes of organizational support strategies for healthcare providers related to adverse patient events. During title and abstract screening, 144 articles did not meet inclusion criteria. The references of the remaining articles (n = 16) were screened and 6 articles were added to the review pool. Twenty-two articles were included in the full text analysis, 16 articles were removed for not meeting the inclusion criteria. Six articles were included in the final extraction and analysis. Results: The 6 studies assessed SVS and organizational support across a variety of healthcare work settings and professions. Findings indicated that healthcare providers believe organizational support after adverse patient events was or would be beneficial for minimizing SVS. They further demonstrated a discrepancy in the types of support strategies healthcare providers preferred or desired after an adverse event, as the level of agreement differed between sampled populations.Conclusion: Healthcare providers believe support from their organization is important after experiencing an adverse patient event, but support strategies may not be universal. Organizations should establish provider support systems for adverse events, but first need to assess provider preferences to implement the strategies most desired. As organizations develop their support systems, they should consider the interprofessional nature of their staffs to aid in collective support following an adverse event.

Utilization of Summative Assessment in Physical Therapy Education to Establish Foundations of Clinical Science Knowledge

Abstract

Purpose: Doctor of Physical Therapy [DPT] students’ ability to apply, integrate, and synthesize foundations of clinical science knowledge is vital to success in clinical practice. The aim of this case study was to explore summative examination quantification of foundational clinical science knowledge as a benchmark toward competence-based education in the first year of a DPT program. Methods: First year DPT students from a private New England University took the Physical Therapy Foundations of Clinical Science [PT-FCS] exam at the end of the second semester following completion of foundational clinical sciences coursework. The PT-FCS exam is a multiple-choice exam comprised of three clinical science categories: human anatomy, kinesiology, and neuroanatomy. Retrospective analysis of PT-FCS exam scores for 223 students over three cohort years was performed to investigate test reliability by cohort and relationships with first year cumulative GPA and progression in the program. Results: PT-FCS scores were reliable across 3 cohorts: 2019, 2020, 2021 (KR20 = 0.74-0.82). Exam scores showed significant (p = 0.01 two-tailed) moderate correlations with current core course GPA with Pearson Correlation coefficients by individual cohorts (r = .70, .73, and .80) and all cohorts combined (r = .73). Conclusion: A retrospective analysis of three years of data informs validation of the PT-FCS for use as an assessment touchpoint to quantify foundational clinical science knowledge in first-year doctoral physical therapy students. Findings of this first-year learner performance outcome may contribute to development of longitudinal benchmarks for assessing disciplinary specific knowledge of foundational clinical science and to inform educational frameworks necessary for clinical competency in physical therapy education. Ultimate predictive ability, and educational value, of summative testing of foundational clinical science will be explored in future categorical and item level analysis in order move toward more competency-based teaching and learning in physical therapy.

Evaluation of Undergraduate Internship Interprofessional Experiences Using the Jefferson Teamwork Observation Guide (JTOG )

Purpose: The purpose of this study was to evaluate and describe the healthy behaviors of teamwork at internship sites of undergraduate health and exercise science students. Data from the Jefferson Teamwork Observation Guide (JTOG) tool, in conjunction with five open-ended debrief questions were used as an innovative means of assessment to evaluate the quality of interprofessional experiences at various internship sites, as reviewed by the internship coordinator. Methods: Students observed an interprofessional team at their internship site and completed the JTOG, for the observed team. The JTOG is a two-part assessment (Likert Scale questions; qualitative questions) of identifiable characteristics of well-functioning teams drawn from the literature about teamwork, team-based care, and client-centered care. Mean Likert scores (SD) were calculated for each of the 14 Likert Scale responses and themes from the five open-ended questions were identified. Results: Students responded that their internship interprofessional teams engaged in friendly interactions and understood the roles and responsibilities of other team members, as well as valued the opinions of others and by demonstrating respect, confidence, and trust in one another. In contrast, areas of improvement were noted in the ability to openly disagree with other team members, as well as the frequency in which team members sought out opportunities to work with others. Comments captured from the JTOG open-ended debrief questions indicate the following six themes from their observations: 1) observable behaviors of effective teamwork (trust, collaboration, unity, common goal; termed shared leadership), 2) modeling collaborative care, 3) practicing client-focused care, 4) communication, 5) understanding roles, and 6) displaying importance of creating a professional environment. Conclusions: The JTOG proved to be a valuable tool: 1) to assess internship site teams within the healthcare field in order to justify the continued partnership between the university and the internship site; 2) to demonstrate that accreditation competencies are met by student learning experiences; and 3) as part of intentional interprofessional education curriculum at the foundational education level within the learning continuum.

Telerehabilitation: An Updated View of Practices, Cost Analysis, and Client Perceptions

Telerehabilitation is an alternative and complementary rehabilitation method in which information and communication technologies are used to remove the distance between healthcare professionals and clients. The COVID-19 pandemic has led to the rapid adoption of telerehabilitation services, limiting the in-person rehabilitation services available all over the world. The restrictions that started with the COVID-19 pandemic also negatively affected rehabilitation services, clients, and healthcare professionals, and it was considered essential to provide services using telerehabilitation technology. Therefore, this review aimed to examine and inform health professionals' telerehabilitation practices such as remote assessment, evaluation, intervention, monitoring, supervision, education, and follow-up during the pandemic. This review aimed to present the practice areas, advantages, disadvantages, perceptions, and cost analysis results of telerehabilitation practices to healthcare professionals, considering the standards the American Telemedicine Association set.

The Impact of Type 1 Diabetes on the Family and Related Factors

Objective: This study was conducted to determine the impact of Type 1 diabetes mellitus and related factors on children and families. Methods: The descriptive study was conducted with the parents of 175 children aged 6-18 years with Type 1 diabetes mellitus. The data were collected using the "Child and Family Information Form" and the "Diabetes Family Impact Scale (DFIS)." pResults:It was determined that the parents' total median DFIS score was 21.42 (9.52-35.71) and the highest median score was 33.33 (11.11-66.66) in the "finances" sub-dimension score. There was a significant difference between the child's school success and the parents' "school" sub-dimension median scores, the mother's employment status and the "work" sub-dimension median scores, and the family's income level and the DFIS total median scores (pConclusions and Recommendations:It was concluded that diabetes mostly adversely affected the family in terms of "finances." It was also determined that the negative impact of diabetes on the family was higher in children with poor school success and in families where mothers were unemployed and whose income was less than their expenses. The negative impact of diabetes on the family increased as the ages of the child, mother, and father and the duration of diagnosis decreased and the HbA1c level increased. In line with the research findings, one should be aware of the factors (child's age, child's school success, parental age, parental employment status, family income level, duration of diagnosis, HbA1c level) that affect the negative effects of diabetes on the family. In addition, it is recommended to plan and implement the necessary initiatives to prevent the negative effects of diabetes on the family (especially in the financial field) since the child's diagnosis of diabetes.

Students Ability to Self-Regulate in a First-Year Experience Health Sciences Course

Purpose: Research has shown students in general do better throughout their post-secondary education if they participated in a First Year Experience (FYE) course. Research questions whether first-year students peform better in face-to-face, online, or blended courses. The purpose of this study was to determine the perceptions of first-year health science students in online and blended learning environments and self-regulation, in a FYE course.

Methods: The study utilized educational design and research tools designed to create and improve teaching and learning practices. For the design of the learning environment, analysis, design, development, implementation, and evaluation (ADDIE) was implemented. Action-based research (ABR) was utilized for analyzing and improving instructional practices. A survey adapted to evaluate self-regulation was used to evaluate perceptions of self-regulation, goal setting, environment, task strategies, time management, help seeking, and self-evaluation and students’ perceptions of instructional modality.

Results: A total of 657 students (online n=295 and blended n=362) consented and participated in the study. Majority of online participants (90%) somewhat agreed to strongly agreed in being efficient in goal setting compared to the blended group at 87%. In the area of environment for studying, 95% of online participants reported having a comfortable, distraction-free environment as compared to the blended group (85%). For the category of learning environment (online vs. blended), 94% of online participants reported being comfortable, compared to 85% in the blended. There was low confidence identified among participants (63%) in the categories of time management, environment, help seeking, and task strategies.

Conclusions: Ways to help students improve and expand their self-regulation skills should be developed in the early years of higher education. The study revealed students were not accessing supplemental resources to aid their learning. Therefore, faculty may need to consider streamlining the supplemental resources made available to students, utilizing the ADDIE model to evaluate their course. Increasing faculty and peer face time, could improve self-regulation skills and make students feel a stronger connection to the learning process and potentially overall academic success.

Leadership Development in Athletic Training: A Qualitative Study

Purpose The purpose of this study was to explore how athletic trainers describe their leadership and how the profession can develop future leaders. Methods: Eight participants (four females, four males) completed a phone interview. Interview data were transcribed, coded, and analyzed utilizing a grounded theory approach. The trustworthiness of the data was established by using member checks and triangulation. Results: Characteristics of Leadership theme was defined as 1) Interpersonal Skills, 2) Vision, 3) Pride in Others’ Success, 4) Ethical Decision Making, and 5) Self-Reflective. The Leadership Development theme was characterized by 1) Role Models Professional and Personal, 2) Involvement and Networking, and 3) Workshops. Conclusions: Leaders in athletic training self-report that they possess strong personal attributes, take pride in the success of others, and demonstrate sound decision-making, which is described as honorable. Future leaders should emulate these attributes as they mature in the profession. Engaging in professional development and role modeling of past mentors helps leaders develop their skills.

Physiotherapy Rehabilitation in Bilateral Lower Limbs Amputations Following Dry Gangrene: A Case Report

Background: Bilateral lower limb amputation is becoming more frequent in recent years. This case report will outline the pre-operative and post-operative physiotherapy protocol for bilateral lower limb amputations following dry gangrene. Additionally, this case was evaluated to see if postoperative physiotherapy treatment consisting of prevention of complications, patient education, independent self-care, and functional mobility improved outcome. Case: A 76-year-old man came to the hospital with clinical features of dry gangrene of both feet. Preoperatively he was given education on care for his limbs along with the therapy plan following surgery. Pain on VAS scales were taken prior to surgery and postoperatively as well. Results: Preoperative education helped the patient improve his pain status, which is an important aspect for postoperative rehabilitation. Decreasing pain on VAS facilitated early rehabilitation which further helped lessening the chances of postoperative complications. Conclusion: Pre- and early post-operation rehabilitation improve patient outcomes such as improved pain levels, range of motion and prevention of complication related to bilateral lower limb amputation.

Teaching and Learning Interventions Designed to Improve Cultural Competence in Health Profession Students: A Systematic Review

Purpose: Developing healthcare profession students’ cultural competency knowledge, skills and attributes is critical to meet the needs of culturally and linguistically diverse healthcare service consumers. The purpose of this systematic review was to identify effective cultural competence interventions for healthcare profession students. Methods: A systematic review of peer reviewed articles published from 2010-2021 using PRISMA guidelines was conducted by searching CINAHL, EMBASE, ERIC, PubMed, and Psych INFO databases. Article quality was assessed using the Evaluation Tool for Quantitative Research and Mixed Method Appraisal Tool. Results: The initial search identified 2,261 potentially relevant studies, 41 studies met the inclusion criteria in which intervention effectiveness was evaluated using a validated outcome measure pre- and post- intervention. Only one study used a non-self-report outcome measure. Out of the 41 studies, only eight studies employed randomisation in the method. Conclusion/Recommendations: This review evaluated effectiveness of cultural competence interventions and evaluation of the intervention using either self-report or non-self-report validated outcome measures at pre- and post-intervention exposure. Combining cultural competence teaching methods such as lectures with simulations, role-playing and community engagement with diverse populations enhanced cultural competence. Further studies are required to compare effective cultural competence teaching models and identify reliable non-self-report outcome measures to assess the effectiveness of interventions post-exposure. Comparing effective cultural competence teaching models that utilise reliable non-self-report outcome measures will be valuable for guiding the design of teaching and learning interventions directed towards cultural competence. Further research is also required to examine the duration of intervention efficacy and how to maintain efficacy post-intervention exposure. Findings from this review are important for designing and structuring of cultural competence curriculum for healthcare profession students and informing future research on cultural competence teaching. This review has identified that most evaluation tools and studies have been designed for the nursing discipline. There is need to design more cultural competence evaluation tools and studies for other healthcare disciplines such as pharmacy and physical therapy.

Preceptor Training: Evaluation of an On-line Educational Module to Improve Preceptor Feedback

Purpose: Effective feedback delivery is critical to behavior modification and skill improvement in novice learners and athletic training programs often use annual training to teach preceptors to develop feedback skills. The purpose of this research project was to evaluate the effectiveness of an on-line asynchronous educational module for improving feedback delivery. Method: We used a single cohort, repeated measures design (pre, post, post-post) and an eAuthoring tool (Softchalk©) and online assessments (Qualtrics® Provo, UT) to evaluate the educational module. Preceptors (n=351) from 17 post-baccalaureate programs began the study; 48 completed all 3 assessments. We delivered a content validated lesson and assessments using various learning theories including video demonstrations with paired reflections. The desired outcome was to enhance the knowledge of effective feedback characteristics to be used in practice. The pre-test assessed self-reported feedback behaviors on a Likert Scale and knowledge (score=25). The immediate post-test reassessed feedback knowledge. At least 8 weeks following completion of the module, participants were asked to reassess feedback delivery behaviors. Throughout the process, participants provided a definition of “effective feedback” scored on 7 key criteria for effective feedback delivery. Descriptive statistics and paired t-tests were used to analyze the data and significance was set at Pa-priori. Results: Significant improvements (P-3.298 P=.001, Cohen’s d=.889). There were no other significant differences between pre-test and follow-up behaviors (P>.05), as participants generally agreed they performed effective feedback behaviors (mode=4) at both time points. Conclusions: Behaviors regarding effective feedback were not changed over the long-term, which may have been a result of the method of performance feedback. Preceptor training is both a requirement and a need in effective athletic training clinical education. Future research should aim to identify mechanisms to improve preceptor feedback and confirm preceptor perceptions through student evaluations.

Inclusion of Sexual Orientation and Gender Identity (SOGI) Cultural Competence in Higher Education Healthcare Programs: A Scoping Review

Purpose: Lack of sexual orientation and gender identity (SOGI) cultural competence in healthcare providers contributes to poor health outcomes in individuals who are lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more (LGBTQIA+). However, SOGI is often overlooked in healthcare education. Existing research shows educational programs in the nursing, medical, and pharmacy professions are incorporating cultural competence training into the curricula. Few studies have explored how SOGI cultural competence is incorporated into occupational therapy (OT), physical therapy (PT), and speech-language pathology (SLP) curricula. Clear guidelines for training on SOGI cultural competence are lacking in these professions. It is important to identify how OT, PT, and SLP educational programs are preparing students to provide culturally competent care to LGBTQIA+ individuals. This scoping review summarizes existing research on this topic and identifies gaps in the literature. Method: A scoping review methodological framework (Arksey & O’Malley, 2005; Levac et al., 2010) was used to search six databases. Descriptive numerical summary and qualitative analysis were used to summarize and interpret the results. Results: A total of 1,091 articles were included in the original search. After the initial title and abstract screening, 55 articles remained. In total, nine articles met the inclusion criteria for this scoping review. Quantitative results describe variation in study participants, SOGI populations, the type and purpose of training, and outcome measures used. Qualitative themes related to SOGI cultural competence include assessment of student and faculty knowledge, and the perceptions and evaluation of course content. Gaps in the literature include long-term changes in knowledge, skills, and dispositions of students; the need for clinical workshops, the quality of self-report in education, outcomes of training programs, and effectiveness of voice training for transgender clients. Conclusions: The benefits of including SOGI cultural competence in the healthcare curricula include increased student knowledge, confidence, sensitivity, cultural competence, and improved attitudes toward LGBTQIA+ individuals. Additional research is needed to develop and standardize training on SOGI cultural competence in the OT, PT, and SLP curricula.

Preceptors’ Experiences Training Public Health Interns in Remote Workplace Settings

Background: The discourse around COVID-19 related challenges to classroom instruction has been highly visible, but little has been published on learning experiences outside the classroom that prepare students to work in the “real world.” Method: We interviewed five Master of Public Health internship preceptors about their experience in 2020 with student interns to formulate pertinent survey questions to distribute to a larger sample. Our questionnaire included closed- and open-ended questions regarding student attributes and skills that shaped the success of the internship. Data were collected from internships sites of one midwestern university. Results: Nearly all 26 preceptors that responded to our survey supervised fully remote internships. Internship sites included academic centers, private companies, non-profits, health systems, and others. Self-motivation, flexibility and organizational skills were considered key student attributes essential to succeed in a remote internship. Being uncomfortable in an online environment or being hesitant or passive were considered student attributes that made remote internships challenging. Preceptors reported that 2020 interns developed different skills compared to previous years, notably, those related to working in an online environment, intrapersonal skills like resilience, and technical skills, such as spatial analysis. Conclusion: As modes of learning and work continue to evolve, internship preceptors will need to learn and adapt to what it takes to support interns to develop relevant skills for remote or hybrid public health work environments. In the meantime, offering clear communication, support, and normalizing remote work cultures may enhance interns’ ability to fully engage and while maintaining the attributes necessary to make internships a success.

Does Acute Fatigue Affect Lumbar Proprioception and Balance?

Purpose: To investigate the acute effects of trunk extensor, abdominal, and calf muscle fatigue on lumbar proprioception and balance. Method: Seventy healthy individuals, aged between 18-25, without pain in the low back and lower extremities, with right dominant lower extremities, were included in the study. Dynamic balance with the Y-balance Test, lumbar proprioception sense with the application of the IOS software, and fatigue level with the 6-20 Borg Scale were evaluated before and immediately after the back extensor, abdominal, and calf muscle fatigue protocols were applied to the individuals at 72-hour intervals. Results: After all fatigue protocols, proprioception sense at 30˚ lumbar flexion was found to change significantly (pConclusionsThis study determined that acute fatigue negatively affects proprioceptive sense and dynamic postural control in the anterior direction. Understanding how the trunk extensor, abdominal, and ankle plantar flexor muscles respond to a fatigue-inducing exercise, especially concerning postural control and trunk proprioception, is important for understanding and preventing injury risk.

Exploring the Transtheoretical Model of Change, Barriers, and Motives to Telemedicine Adoption in Athletic Training

Purpose: The delivery of healthcare services by athletic trainers (ATs) has evolved over the past two years as a result of the COVID-19 pandemic. Previous research has identified an integration of telemedicine as a necessary, urgent replacement for face-to-face patient encounters in athletic training; however, there is a lack of data to support the habitual and intentional change to one’s clinical practice that includes telemedicine. Therefore, the purpose of this study was to identify and analyze ATs respective stages of change related to telemedicine adoption, as well as explore motivating factors and barriers related to the adoption of telemedicine. Methods: We performed a cross-sectional study of 883 credentialed ATs. The survey contained a modified TTM stages of change assessment and 51-item telemedicine barriers and motives tool adapted from previous literature. A logistic regression was performed to assess highest level of education with telemedicine adoption status. Results: Overall, most ATs were categorized in the action, maintenance, and termination stage (n=551/882, 62.4%) for telemedicine adoption. Other participants were categorized in the stages as unaware (n=8, 0.9%), precontemplation (n=82, 9.3%), contemplation (n=78, 8.8%), and preparation (n=164, 18.6%). The logistic regression model was statistically significant (pConclusions: The results of the study suggest that most ATs have recently changed their delivery of healthcare in the last 6+ months and intend to maintain telemedicine use as part of their clinical practice. Additionally, telemedicine success was hampered by a lack of exposure but did feel that telemedicine fills gaps in patient care and addresses improved patient satisfaction. Additionally, increasing an ATs highest level of degree earned was associated with an increased likelihood of being in stage five on the modified-TTM assessment suggesting focused, professional development could sustain telemedicine use in athletic training.

The Current Youth Sport Culture and its Impact on Sport Participation Experiences of Low Socioeconomic Status Families

Purpose: The rise of sport specialization can jeopardize the opportunities for families of low socioeconomic status (SES) to participate in organized sport. However, obtaining an athletic scholarship may be a motivating factor for low SES youth to sport specialize. Yet, the experiences of low SES athletes in sport participation are not well known. Method: We used an Interpretative phenomenological analysis (IPA) to explore experiences of low SES families with children participating in sport and how this may be impacted by the current youth sport culture that promotes sport specialization. We engaged in semi-structured interviews with 12 low SES parents. Results: The following 4 interrelated themes emerged: (a) Benefits of youth sport participation, (b) Negatives and/or barriers to youth sport participation, (c) Strategies to get involved in youth sport, and (d) Facilitators for youth sport participation. Conclusions: Findings indicate that while low SES youth sport parents are motivated to involve their children in sports, there are many barriers that hinder their opportunities for their child to participate in organized sports. These issues are exacerbated by the current youth sport culture which emphasizes sport specialization with very few existing facilitators to involve their child in organize sport.

Relationship Between Allied Health Student's Behavioral Style and Ideal Clinical Instructor Behaviors

Purpose: The focus of this research is to understand the relationship between students' primary DISC behavioral styles (dominant, influencing, steadiness, compliance) and their perception of ideal clinical instructor behaviors. A review of the literature supports the connection between the behaviors of the clinical instructor (CI) and the success of the allied health professional student (AHPS). Additionally, a body of research supports the connection between DISC behavioral styles and student success. The purpose of this study is to examine the relationship between AHPS primary DISC behavioral styles and their perception of the ideal CI behaviors. Methods: A total number of n=90 participants completed the Allied Health Professional Preceptor Assessment exploring ideal CI behaviors and the DISC assessment across the three disciplines of athletic training (14), exercises science (7), and physical therapy (69). Results: S (steadiness) scores had the highest frequency (53.3%), followed by I (influencing) (22.2%), then C (compliance) (13.3.7%), and lastly, D (dominant) (11.1%). Using regression modeling, the "D" model (p=0.01) and the "S" model (pConclusion:This study provides preliminary evidence for the DISC behavioral assessment as a tool to inform CIs in ways to engage AHPS effectively. The findings of this study provide applicable techniques for CIs mentoring students with "D," "S," and "C" primary behavioral styles. Further research is warranted to determine engagement strategies for "I" primary behavioral styles. By leveraging these findings, clinical education programs can provide CIs with simple behavioral techniques to best engage students based on the student's primary behavioral style.

Exploring Family-Centered Care from the Perspectives of Home-Health Physical Therapists

Background and Purpose: Older adults often need caregivers to help them age in place successfully while maximizing their quality of life. These caregivers have the highest rates of burnout, injury, and turnover. Family-centered care (FCC) involves collaboration between the healthcare practitioner and the patient, family members, and caregivers. There is a paucity of evidence on how FCC is applied to older adults and their caregivers. The purpose of this general qualitative study was to explore how a group of home health physical therapists (HHPTS) deliver FCC to care-dependent older adults.

Methods: This general qualitative study used individual, semi-structured interviews with a purposeful sample of 14 HHPTs working for a variety of home health agencies in San Diego County. The interview responses were hand transcribed, hand coded, thematically analyzed, and conceptualized in the International Classification of Functioning, Disability, and Health model (ICF model). The coding table and interview guide were modified based on reviews by experts in home health physical therapy. A proprietary coding software program called NVivo was used to triangulate the results.

Results and Discussion: The 3 main themes that emerged were: (a) "FCC is Complex"; (b) "FCC Impacts Older Adults' Health Factors"; and (c) FCC is Impacted by Contextual Factors". Eleven subthemes also emerged. The themese and subthemes were conceptualized within the ICF Model. The first theme demonstrated that the HHPTs had a variety of understandings of, training on, and applications with FCC. The HHTP was conceptualized as an environmental factor that could impact the patient's health based on their knowledge and skills with FCC. The second theme demonstrated that FCC was utilized to address every ICF health factor by the HHPTs. This theme was conceptualized around the entire ICF Model. Neurological conditions and motivated families were seen as large factors in performing FCC. The third theme demonstrated that a wide variety of contextual factors impacted the HHPTs ability, time, and resources to perform FCC. This was conceptualized in ICF Model as personal and environmental factors that could facilitate or inhibit ("+/-") FCC approaches by the HHPTs.

Conclusions: This study closed some of the gaps in the literature on how FCC is delivered to older adult clients, their caregivers, and their family members. This knowledge may help to foster changes in FCC approaches and research. Changes like these could lead to improved health outcomes for older adults through reduced hospital readmissions and improved caregiver satisfaction with care as seen in pediatrics.

Key Words: Family-centered care, home health physical therapist, caregiver satisfaction, burnout, and International Classification of Functioning, Disability, and Health model.

Recovery of Lung Function, Dominant Handgrip Strength, and Health-Related Quality of Life in Cardiac Surgical Patients Following Hospital Discharge

Purpose: Assessment of recovery in post-cardiac surgical patients is commonly conducted using lung function, dominant handgrip strength (DHGS), and health-related quality of life (HRQoL). The aim of this study was to determine the recovery of lung function, DHGS and HRQoL in cardiac surgical patients at six-weeks and six-months after hospital discharge. Further, this study investigated the association between these parameters and the predictive ability of DHGS for lung function and HRQoL. Methods: This was a prospective observational study that involved 58 cardiac surgical patients who completed lung function, DHGS, and HRQoL assessments pre-operatively, at six-weeks, and six-months after hospital discharge. Lung function was assessed using three different calibrated spirometers, while DHGS was measured using three different calibrated handgrip dynamometers. The Short-Form 36 questionnaire was utilized for HRQoL assessment. Results: At six-weeks after hospital discharge, lung function and DHGS were significantly (pConclusion:Variable changes were identified in lung function, DHGS, and HRQoL in cardiac surgical patients at six-weeks and six-months after hospital discharge. Dominant hand grip strength may have limited or no value in predicting lung function and HRQoL in cardiac surgical patients during the intermediate recovery period.

An Investigation of Burnout and the Use of Meditation as Means of Prevention in In a Program of Study for Physician Assistants

Purpose: The purpose of this investigation was to develop, describe, and evaluate burnout curricula using meditation as a burnout reduction strategy. Method: The Maslach Burnout Inventory was the survey method used to assess PA student’s levels of burnout after completing developed burnout curricula. Results: The results showed no relationship between burnout curricula completion and rates of student burnout. However, the findings showed burnout differences across the three cohorts of student classes. Conclusion: While limited by only the three cohorts of students, the study affirmed the need for faculty to stay attuned to aspects of student burnout.

Secondary School Coaches’ Perceptions of Sport-Related Concussions: A Qualitative Approach

Purpose: This study was conducted to understand current perceptions of secondary school coaches on concussion culture, safety, and management. Method: In this consensual qualitative research study, 17 secondary school coaches participated (12 males, 5 females). Participants were recruited through the state secondary school athletic associations. Participants were interviewed over Zoom using a semi-structured interview guide to allow for flexibility (16 questions). All interviews (30 - 60 minutes in length) were recorded and transcribed. A codebook, including themes and subthemes, was created and data were analyzed using thematic analysis. The researchers each reviewed the transcripts separately. The initial codebook was determined using a sample of transcripts; following consensus, another subsection of transcripts was analyzed to determine codebook effectiveness. The research team went through 5 phases of analysis to ensure agreement on the themes and subthemes of each transcript. Trustworthiness was established through peer review and member checks. Results: We discovered four themes 1.) reporting, 2.) concussion education, 3.) awareness, and 4.) culture. Participants described their players’ preferences, attitudes, and willingness for reporting and to whom players report. Coaches indicated that players primarily report concussions to their coaches and may apprehensively report to the athletic trainer. The concussion education that coaches receive was described, including the platforms, type, frequency, and suggestive changes. Many participants described their annual concussion education as repetitive and needing updates. Emphasis was placed on the lack of player education. Coaches identified a need for content to improve players’ concussion reporting and education. Lastly, participants emphasized the culture surrounding concussions in their sport and the preferences on concussions from both player and coach perspectives, the attitudes of the players in their sport surrounding concussions, past attitudes and culture in their sport, player safety, and long-term concerns. Conclusions: Secondary school coaches expressed the current mandated concussion education video was the same annually and could be updated with new information and be more engaging, while also expressing the need for educational content for students. Further efforts should be placed on concussion informational videos, fact sheets, and education for students to increase reporting behaviors, improve sports culture regarding concussions and enhance player safety.

Using Motivational Interviewing to Increase Confidence in Nutritional Counseling Among Dental Hygienists: A Pilot Study

Purpose: Dental hygienists have the unique opportunity to educate patients on connections between nutrition and oral health. Dental hygiene students are introduced to these concepts but struggle to gain confidence to share this knowledge with patients. This pilot study looked at an educational module on motivational interviewing (MI) and an assessment and counseling tool to build student confidence with nutritional counseling. Methods: Dental hygiene students participated in an educational module to review MI and introduce a nutritional risk assessment and counseling tool. Prior to the module, participants completed a pretest about confidence levels regarding MI and nutritional counseling. After three weeks of clinical practice, participants completed a posttest. Data was compared for quantitative changes and qualitative themes from responses. Results:  Twenty-two senior dental hygiene students (n = 22) participated in both the pretest and posttest. There were statistically significant changes in participants’ confidence (p = 0.007) and comfort (p = 0.020) discussing nutrition with patients. Participants struggled to become more confident in MI as demonstrated by no significant change in their feelings surrounding MI (p = 0.150). Students reporting increased nutritional counseling sessions showed improvement in their confidence. Conclusion:  Introducing MI with an assessment and counseling tool to aid students can improve confidence with nutritional counseling. This type of education may translate into more chairside discussions about nutrition, improving overall patient care.

Athletic Training Preceptor Perceptions of Interprofessional Collaborative Practice in Clinical Learning Experiences

Background: Interprofessional education and collaborative practice are standards that have been added to the accreditation standards for athletic training education. Athletic training educators will need to provide interprofessional experiences to their students to remain compliant with the standards. The goal of the mixed methods study was to explore athletic training preceptors' perceptions of interprofessional education and collaborative practice in the clinical setting. Methods: A total of 34 athletic training preceptors completed the full online survey, and of those, 5 completed the semi structured interview. Participants completed an asynchronous online module and a retrospective pretest survey using the ISVS-21 about their beliefs, behaviors, and attitudes about interprofessional education and practice. Participants that volunteered were asked additional questions during a semi-structured interview. Results: The findings of this study found that the educational module was effective in increasing the beliefs, behaviors, and attitudes of athletic training preceptors with a short online module and that preceptors had positive attitudes/beliefs about IPE/IPCP, however, preceptors identified lack of education about IPE/IPCP and barriers to implementing IPE/IPCP with and without students that influenced their use of IPE/IPCP. Conclusion: Athletic training programs could educate and develop athletic training preceptors in interprofessional education and clinical practice to help develop opportunities for athletic training students in the clinical setting.

Cannabis Content in Athletic Training and Physical Therapy Curriculums in the United States

Background: Cannabis is the most commonly used illicit drug in the U.S. and its use is becoming more popular with the legalization of medical marijuana. Currently, 36/50 states and the District of Columbia have legalized marijuana for medical purposes. These changes have allowed for more cannabis-related research to be conducted. It is unknown how health professional education programs such as physical therapy and athletic training have integrated cannabis-related curriculum into their students’ training. This study aimed to identify how physical therapy and athletic training education programs are approaching teaching students about cannabis-related topics. Methods: There were 111 individuals from 40 states who responded to the survey (Males=53; Female=58), including 88 athletic training and 23 physical therapy faculty. Methods: An email was sent to all program directors of athletic training and physical therapy programs in the US with a Qualtrics survey link for faculty to complete. The 23-item questionnaire included closed-ended questions on demographics, where they sought cannabis-related information, and whether program curriculum includes cannabis-related topics. Frequencies were computed for sources of cannabis-related information and whether program curriculum includes cannabis-related topics. Results: Sixty (53.5%) participants stated they have not received information or completed any training related to cannabis. Of those receiving information or completing training (n=51), the most common sources of information were live lectures (n=23), peer-reviewed manuscripts (n=24), and social media/news (n=21). Also, 43 (38%) participants noted teaching cannabis-related topics in their curriculum. However, 33 participants reported either not completing training related to cannabis or being self-educated through the current literature. Conclusions: These results suggest program faculty may benefit from formal cannabis education in an effort to adequately integrate the content into curriculums.

Burnout Syndrome Among Respiratory Therapists in Saudi Arabia

Background: Burnout (BO) is a consequence of chronic work-related stress exposure and impacts healthcare workers' performance, efficiency, and quality of care. Purpose: The study aimed to assess the BO among respiratory therapists (RTs) in Saudi Arabia and examine the association between BO and sociodemographic data and professional satisfaction. Methods: A cross-sectional study involving a convenience sample of RTs in Saudi Arabia was conducted utilizing the Maslach Burnout Inventory (MBI) in addition to questions regarding sociodemographic information and professional satisfaction. Three dimensions typify BO syndrome in the MBI questionnaire: emotional exhaustion, depersonalization, and low personal accomplishment. Statistical Package for the Social Sciences (SPSS) version 27.0 was used to analyse the data. To make comparisons between two continuous variables, independent samples t-tests were used. A one-way ANOVA test was used for factors with more than two categories. Two hundred thirty-six RTs (N=236) were surveyed in this study. The majority of the respondents were male n=130 (55.1%), single n=140 (59.3%), and lived in the central region n=136 (57.6%). The age of the participating RTs in the study ranged from 20 to 58 years, with an average of 28.5 years (SD±5.08). Results: The results showed that RTs had a high level of emotional exhaustion with a mean of 31.97, a moderate level for depersonalization with a mean of 11.39, and a moderate level for lack of personal accomplishment with a mean of 33.58. Age, gender, the role of the RTs, hours of work, and shift schedule of the participants were associated with BO. The workload was the most work factor among RTs associated with BO. Professional satisfaction of work-life balance, the current job, and monthly income were related to the burnout levels across the three subscales. Conclusion: This study was the first to explore BO by MBI and related factors among RTs in Saudi Arabia. Burnout seemed to be a common problem among RTs in Saudi Arabia and was associated with sociodemographic information and professional satisfaction. The findings may help to develop effective intervention strategies to limit and prevent BO. More prospective studies are required with a larger number of participants of RTs.

Occupational Transitions of Family Caregivers of Loved Ones with Dementia

Purpose: The primary purpose of this study was to explore how family caregivers of people with dementia experience transitions in occupations as they assume the caregiver role. Because unpaid family caregivers play a vital part in the scheme of health care, it is important to understand their supports, their perceptions of themselves as caregivers, and the impact of caregiving on relationships, identity, and physical and mental health. Many researchers have studied the effects of caregiver burden, yet minimal attention has been given to the lived experiences of caregiving on their daily roles and routines. Methods: A qualitative descriptive design was used to obtain data from eight caregivers through semi-structured interviews. Content analysis was then applied to all data. Results: The following categories were identified: 1) Benefits, which consisted of the positive experiences gained as a result of caregiving; 2) Consequences, which included the physical, mental, and emotional burdens attached to being a caregiver; and 3) Supports, which were positive resources utilized by caregivers to be both better prepared to care for their loved ones and more capable within their caregiving role. Conclusion: Findings confirm that unpaid caregivers of loved ones with dementia experience dramatic changes in many aspects of their lives. Caregivers felt a strong responsibility as a family member to provide care for their loved ones. It has been found that caregivers spend most of their time engaged in caregiver related tasks, consequently impacting their occupational balance and ability to engage in what they would like to do. Health care providers must be mindful of the changes that caregivers experience, by assisting them to increase supports, anticipate the consequences, and recognize and value the benefits.

“Pieces of Myself”: The Pedagogical Power of an Illness Narrative Assignment for Doctor of Physical Therapy Students

Abstract:

Purpose: Narrative medicine in healthcare education is used to promote a deeper understanding of the illness experience to promote compassionate, patient-centered care. The purpose of this qualitative study was to explore first year physical therapy students’ perceived learning after completing a first-person illness narrative assignment within a required Whole Person Care course prior to clinical experience. Method: Fifty-nine first-year doctor of physical therapy students completed an illness narrative assignment of a known individual with an illness experience from the first-person perspective. Data from students’ reflections on completing the illness narrative assignment were analyzed. Themes organically emerged from the open-ended prompt “What do you feel you learned writing the illness narrative?” Results: Four primary themes of perceived student learning emerged: deeper understanding of oneself, cognizance of values, understanding the illness experience of others, and recognition of future professional role. Three of these primary themes correlate with constructs of professional identity formation. Results substantiate previous studies advocating the use of narrative medicine to facilitate patient-centered care and professional identity development in healthcare education. Conclusions: A single illness narrative assignment with reflection created deeper understanding of the human illness experience for patient-centered care and supported physical therapy student professional identity development prior to clinical experience. This study adds to the limited research on effectiveness of narrative in physical therapy curricula. It also informs educators of a pedagogical approach early in curricula to leverage student professional identity formation. The study additionally answers the recommendations for research on effective implementation of humanities, early integration of narrative pedagogy, and the creation of learning spaces to support student professional identity formation.

Ethnicity Does Not Impact Physical Therapy Students’ Clinical Readiness and Performance, a United States Exploratory Study

Purpose: To explore the impact of ethnicity on clinical readiness and performance among Doctor of Physical Therapy (DPT) students, as determined by 1) Physical Therapist Self-Efficacy (PTSE) score, 2) self-confidence treating patients, and 3) final American Physical Therapy Association (APTA) Clinical Performance Instrument (CPI) clinical reasoning and summative ratings during clinical experiences. Methods: This study is a survey-based, descriptive, and exploratory cross-sectional research design involving sample of 211 DPT students evaluated for differences across ethnic students’ groups 1) PTSE score during student clinical experiences, 2) confidence with treating initial and subsequent same-patient visits, and 3) final CPI clinical reasoning and summative scores during clinical experiences. Results: Kruskal-Wallis test showed no difference across ethnic groups (American Indian or Alaskan Native, Asian/Pacific Islander, Black or African American, Hispanic, White or Caucasian, prefer not to answer, and multiple ethnicity) in 1) clinical reasoning self-efficacy (PTSE), n=211, p=.438; 2) confidence treating at initial visit n=211, p=.088 and subsequent patient visits n=211, p=.584; and 3) clinical performance on the CPI for clinical reasoning n=211, p=.273 and summative n=211, p=.189 scores. Conclusions and Recommendations: All ethnic groups demonstrated strong clinical readiness and performance during each clinical experience level. Ethnic groups did not differ on clinical reasoning self-efficacy or confidence treating patients. Although the gap appears to be closing, there continues to be underrepresentation of ethnic groups in DPT programs. We recommend investigating factors impacting underrepresentation of ethnic groups in DPT academic programs to explore initiatives to close the diversity gap and best match societal representation.

Interprofessional Poverty Simulation Affects Student Attitudes Toward Poverty and Interprofessional Relationships

Purpose: Poverty simulations in health professions education involving multiple disciplines have been studied, but the impact of poverty simulations on interprofessional attitudes has been surprisingly neglected. The purpose of this study was to determine the impact of the Cost of Poverty Experience simulation on attitudes toward interprofessional communication, learning, and collaboration, while still positively impacting attitudes toward poverty. Methods: Poverty simulations were held annually at a private midwestern university involving students from multiple disciplines inside and outside healthcare. Debriefing questions related to professional roles and teamwork were used to promote discussions between students from different professions about caring for clients experiencing poverty. Data from the 2017-19 events are detailed in this article. Over the three years, 325 students participated in the study. The University of West England Interprofessional Questionnaire and the Attitudes Toward Poverty Short Form were administered pre-and post-intervention. Results: The University of West England Interprofessional Questionnaire showed a significant (ppConclusions: The interprofessional poverty simulation experience positively impacted attitudes toward interprofessional communication and relationships while still significantly improving attitudes toward poverty. This finding adds to the literature by demonstrating that interprofessional poverty simulations can positively impact attitudes toward interprofessional communication and relationships when debriefing questions guide discussions about interprofessional roles and teams in caring for those living in poverty.

Preparing for the Next Disaster: Lessons Learned From the Early Experiences of Autistic Adults During the COVID-19 Pandemic

Purpose: Disasters, such as the worldwide COVID-19 pandemic, create significant disruptions for individuals and their communities. Understanding these disruptions is a first step towards planning for future events and disaster recovery. This research aims to explore how the initial COVID-19 restrictions, including lockdowns, impacted adults with Autism (ASD). Method: Using semi-structured interviews to understand how individuals with ASD experienced the early months of the COVID-19 pandemic, twelve participants were interviewed: six individuals with ASD (ages 20-38), three parents of individuals with ASD, and three support staff for individuals with ASD. Analysis: Grounded theory methods were used to analyze the impacts of COVID-19 based on the knowledge, challenges, activities, resources, and support needs of individuals with ASD. Results: Interviews were coded. The questions generated three themes with eleven subthemes 1) COVID Knowledge: Understanding COVID, Preventative behaviors, Information resources; 2) Pre-COVID activities: social, work/day-program/school, environment, physical activities, and 3) During COVID activities: social, work/day-program/school, environment, and physical activities. Conclusion: Individuals with ASD’s understanding of COVID-19 is similar to the general public and display adequate, timely knowledge. They adopted new behaviors, including transitioning from structured physical schedules to less structured virtual schedules. Caregivers and support staff expressed concerns about preventative behaviors in the community.

Mealtime Experiences of Children with Autism Spectrum Disorder from the Perspectives of Filipino Occupational Therapists in Cebu: Implications for Practice

Purpose: Occupational therapists (OTs) handle children diagnosed with autism spectrum disorder (ASD), and a common concern is how their sensory processing issues affect their feeding habits. There is limited information regarding interventions about this issue both locally and internationally. This study aims to know the experiences of OTs providing feeding interventions associated with sensory issues for children with ASD. It will also describe what approaches they used for these interventions. Method: Qualitative phenomenology using in-depth interviews with nine OTs in Cebu, Philippines was conducted, and data underwent thematic analysis. Results: Five themes emerged: 1) a family that feeds together, stays together, 2) key to mealtime challenges, 3) root of mealtime challenges, 4) highs and lows of a therapist on feeding interventions, and 5) teletherapy as a sign of times. Conclusion: OTs and parents look at foundational skill deficits of a child with ASD and relate the said skill deficits to mealtime behaviors and challenges. Results provided in-depth description of what current intervention approaches the selected therapists choose and how they are applied and combined in targeting feeding concerns and sensory issues that relate to feeding. Handling feeding issues is also an opportunity for OTs to work with other healthcare professionals.

Professional Perspectives on Bilingualism in Persons with Autism Spectrum Disorder: A Pilot Study

Purpose: The present study examined the perspectives of professionals regarding bilingualism and ASD. Methods: A total of 27 professionals participated in this study. Data was collected via an online survey. The survey was designed based on a literature review and consultation with a team of experts in the field of ASD. Information relating to demographic information, professional practice information, and perspectives of bilingualism and ASD was collected. Results: Professionals participating in the present study were most likely to agree with the statement, “A child with ASD from a bilingual household is able to understand both languages” and least likely to agree with the statement, “There are enough bilingual service providers and resources.” Responses to 5 of the 8 statements related to professional perspectives on bilingualism in children with ASD were near the scale midpoint indicating the participants did not strongly agree nor disagree with the perceptions. When asked what language parents should speak to their children with ASD from a bilingual household, 44% of participants recommended a bilingual approach, and 30% indicated a monolingual approach. Participants reported professional experience and the ability to communicate with caregivers/others in the environment/parent language use as influences for these recommendations. Furthermore, sex, level of education, and bilingual caseload were found to be significantly related to perspectives on bilingualism and ASD. Conclusion: The results of this study support previous literature which has identified a disconnect between research and clinical practice regarding bilingualism and ASD. Furthermore, the relationship between specific demographic and professional variables found in this study can now be used by future research studies and programs targeting bilingualism and ASD. These findings are of particular importance when considering that research has supported bilingualism in children with ASD, yet many professionals continue to implement a monolingual approach. A better understanding of professional perspectives of bilingualism in ASD provides insight into the discrepancy between research and clinical practice and paves the way for future studies and programs targeting improved services for bilingual children with ASD.

Influence of Years of Experience on Clinical Competence of Novice Physical and Occupational Therapists in Japan

Purpose: To increase the clinical competence of novice physical and occupational therapists, an accurate assessment of their clinical competence is necessary. However, no previous study has objectively analyzed the changes in novice therapists’ clinical competence in Japan. Hence, this study investigated and evaluated the changes in the clinical competence of such therapists using an objective analysis. Method: The study included 34 novice therapists with 1–3 years of experience in clinical practice. Participants were divided into groups according to their years of experience. The clinical competence of the novice therapists was evaluated twice using a clinical competency evaluation scale. For comparison among the 3 groups, the scores of the first evaluation were used. For comparison within each experience-year, the scores from both evaluations were used. Results: A comparison of the 3 groups showed that therapists with 3 years of clinical experience had significantly higher clinical competence than therapists with 1 year of clinical experience. Between the first and second evaluations, all therapists with 1 year of clinical experience demonstrated increased scores, whereas scores decreased by approximately 50% for therapists with 2–3 years of clinical experience. Conclusion: These findings suggest that it is necessary to increase educational opportunities for therapists with 2−3 years of clinical experience and re-examine the content of their education and training.

Introducing a Physical Therapist-Led Acceptance and Commitment Therapy Training for Pain: A Clinical Perspective

Purpose: Mounting evidence supports the use of cognitive and behavioral techniques as part of physical therapist practice. These methods are used within a physical therapist’s multimodal treatment approach for the management of pain and to facilitate health behavior change. There is a multitude of evidence-based cognitive behavioral techniques to choose from including newer approaches based on Acceptance and Commitment Therapy. Yet few studies have examined physical therapists’ perceptions to learning and implementing ACT into clinical practice. The purpose of this manuscript is to present a clinical perspective of physical therapists learning about and incorporating Acceptance and Commitment Therapy in clinical practice. Methods: An 8-week online physical therapist-led ACT for chronic pain training was completed by 65 physical therapists. A post-training evaluation was developed and then scored by 46 participants. The evaluation included 15-questions with regard to the self-reported perceptions of learning foundational ACT skills necessary to implement into physical therapy practice, a deeper understanding of psychological factors involved in musculoskeletal pain, confidence in managing musculoskeletal pain, utility in physical therapist practice, and the recognition of a new or different approach to treating musculoskeletal pain. Results: Participants’ self-reported perceptions were highly positive with 73% reporting the training furthered their understanding of psychological factors in chronic musculoskeletal pain and 100% reported learning the foundational ACT skills necessary to implement it into physical therapy practice. In addition, 7 sub-themes regarding the ACT training emerged from a qualitative content analysis and included the following: 1) The training filled a knowledge gap in understanding of how to assess and treat psychological factors related to pain, 2) A mixture of prerecorded video training, reading, experiential exercises, and self-reflection via the ACTPTE were critical to reinforce learning, 3) Coaching and supervision calls were a useful part of the training and helped to translate course knowledge and implement into clinical practice, 4) Having an opportunity to practice in a group setting with like-minded peers was a critical component of confidence building, 5) Ongoing communication, networking, and mentorship via the online forum and coaching calls allowed participants to complete the course material on-time, stay connected, and share stories and experiences about implementing the material in practice, 6) The ACT stance of not changing pain or related psychological content (example: not changing thoughts, pain related beliefs, reconceptualizing pain) may run counter to other psychologically-informed approaches found in physical therapy practice and took some time for practitioners to process and integrate, 7) Some practitioners expressed that ACT helped them cope with work-related stress and burnout and to drop the struggle of fixing or curing every patient with pain. Conclusions: ACT delivered via an online training was acceptable to physical therapists and supervision calls were necessary for confidence building and implementation into practice. The ACT model was perceived as adaptable to the practice of physical therapy as well as the complex clinical and psychosocial presentation of many chronic pain conditions. Future investigations should explore brief training interventions, treatment fidelity, long-term outcomes, the development and validation of a scale to measure knowledge, concepts and skills conceptualizing psychological flexibility within physical therapist practice.

An Examination of Emotional Resilience among Athletic Trainers Working in the Secondary School Setting

Purpose: Athletic training is a demanding profession that is a stressor for many practitioners. Emotional resilience allows Athletic Trainers (ATs) to persist in their roles and benefit from long and successful careers. The purpose of this study was to explore the level of emotional resilience of ATs working in secondary school settings and identify factors perceived to contribute to or mitigate one's emotional resilience. Method: A sequential explanatory mixed-method design using a cross-sectional online survey followed by in-depth interviews was used to gather information from 160 (16% response rate) secondary school NATA members - 97 (60.6%) female; 63 (39.4%) male with 13.28+9.46 years of experience. Six individuals (5 female, 1 male) participated in a follow-up semi-structured interview. The Connor Davidson Resilience Scale (CD-RISC) was used to measure perceptions of individual emotional resilience. Open-ended questions were also used to gather information from the participants who agreed to participate in a follow-up semi-structured interview about the factors perceived to both facilitate or reduce emotional resilience. Results: The mean emotional resilience score (79.84 ± 11.38) for the sample was consistent with the average US adult population. Only 14.1% of the sample reported high emotional resilience scores. There was a significant positive correlation between emotional resilience scores and years of experience as an AT (r(158) = .16, P = .048) and age in years (r(158) = .16, P = .048). There was no significant difference between emotional resilience and academic degree earned (F(2,157) = .775, P = .83). The inductive analysis resulted in the following emergent themes that were perceived to facilitate ones’ emotional resilience: social support, communication, self-care, and past experiences. Also, the following emergent themes were perceived to reduce ones’ emotional resilience: emotional responses and role overload. Conclusion: The results of this study help understand secondary school ATs' perceptions of and factors that contribute to their emotional resilience. Strategies are suggested to help ATs develop emotional resilience to manage their occupational stress and reduce feelings of burnout.

Translation, Cross-Cultural Adaptation, Reliability, and Validity of the Tamil Version of Fear-Avoidance Beliefs Questionnaire in Chronic Low Back Pain

Background: Excessive fear of movement, restricted physical activity, and cognitive distortions are frequently found with chronic low back pain (CLBP) subjects. The Fear-Avoidance Beliefs Questionnaire (FABQ) is the most well-founded and often used tool to measure fear and avoidance beliefs in CLBP subjects. In India, there is a diversity of culture, educational level, and language. So, there is a need to translate FABQ into the regional language Tamil, which will improve understanding of FABQ and reduce the language barrier of the Tamil population. Objective: To translate, cross-cultural adapt, and investigate the psychometric properties of the Tamil version of FABQ in CLBP subjects. Materials & Methods: The standard translation and adaptation guideline was used to translate FABQ into Tamil version FABQ. CLBP subjects referred to a low back rehabilitation program in an outpatient clinic took part in this study. They completed a FABQ-Tamil questionnaire [includes subscales for Physical Activity (FABQ-PA) and Work (FABQ-W)], pain rating visual analog scale and the Roland- Morris Disability Questionnaire (RMDQ)-Tamil version, on two occasions five days apart. Test-retest reliability, internal consistency and validity were evaluated. Results: Fifty CLBP subjects participated with a mean age of 39.94 (± 15.55) years. Convergent validity analysis displayed a moderate correlation between FABQ-PA and VAS (r = 0.63); FABQ-W and VAS (r = 0.64). Divergent validity analysis demonstrated a moderate correlation between FABQ-PA and RMDQ (r = 0.69) and a good correlation between FABQ-W and RMDQ (r = 0.85). The test-retest reliability was high; the intra-class correlation coefficients of FABQ-PA and FABQ-W were ICC-0.90 and 0.94, respectively. Cronbach's alpha for the FABQ-PA and FABQ-W were 0.87 and 0.92, demonstrating high internal consistency. Conclusion: The findings of this study demonstrated that the FABQ-Tamil version questionnaire is a reliable and valid measure of fear of pain and fear-avoidance beliefs in the Tamil-speaking CLBP subject.

Assessment of Inter-Instrument Reliability for Dominant Handgrip Dynamometry and Spirometry

Purpose: The aim of this study was to determine the inter-instrument reliability of different dynamometers and spirometers commonly used in clinical practice. Methods: The study involved 113 healthy volunteers across three facility sites. At each site, dominant handgrip strength (DHGS), and lung function (forced expiratory volume in one second [FEV1], forced vital capacity [FVC] and peak expiratory flow rate [PEFR]), were compared using a local and reference device. Assessments were randomized with five minutes rest between measurements. Significant differences between devices were assessed using paired t-test while relative reliability between devices was determined via intra-class correlations (ICC). Accuracy index and variability between measurements were assessed using the technical error of measurement (TEM%) and coefficient of variation (CV), respectively. Agreement between devices was determined using the Bland Altman’s plot with limits of agreement (LOA). Results: The local devices recorded significantly (p1 (3.1%-8.4%), FVC (3.1%-13%) compared to the reference devices. Good-excellent correlations (ICC=0.89-0.96), unacceptable CV (5.8-9.9%) and TEM% (6.6-9.9%), and large mean biases (3-9kg) and LOA (3-23kg) were identified between the local and reference dynamometers. Excellent correlations (ICC=0.91-0.99), and mostly unacceptable CV and TEM% were identified between the local and reference spirometers for FVC and PEFR. Compared to the reference device, all local spirometers showed unacceptable (-0.134 to -0.536 liters) and acceptable (-0.12 to 0.05 liters/second) mean biases for FVC and PEFR, respectively. Conclusion: Unacceptable inter-instrument reliability was identified between local and reference dynamometers and spirometers for measuring DHGS and all lung function indices, respectively. Across clinical settings, comparing DHGS and lung function between different brands of devices may lead to the reporting of erroneous results with corrective adjustments required for clinical practice.

Assessment and Diagnostic Practices Relating to Autism Spectrum Disorder in the United States and Mexico

Purpose: The present study examined and compared professional assessment and diagnostic practices relating to autism spectrum disorder (ASD) in Mexico and the United States (U.S.). This information is of great importance because there is an extremely limited amount of information pertaining the assessment and diagnostic practices for ASD in Mexico and little is known about how these practices compare to those in the U.S. Methods: Archival data from a survey investigating ASD in the U.S. and Mexico was used for this study. Participants included 29 professionals from the U.S. and 7 professionals from Mexico. Professionals were from a variety of different occupations, but all reported to be involved in the diagnosis of ASD. Results: In both Mexico and the U.S., most professionals reported use of similar ASD related assessment and diagnostic practices, and ASD related assessment and diagnostic practices were frequently in alignment with current best practices recommendations. However, there were professionals from both Mexico and the U.S. that reported use of diagnostic tools and practices that did not adhere to recommendations, such as, use of outdated versions of the DSM, diagnosis of ASD individually, and evaluation of individuals in one setting. Conclusion: An understanding of the assessment and diagnostic practices currently being used in Mexico and in the U.S. provides both researchers and clinicians with a better understanding of what is being implemented by different professionals. Additionally, an understanding of the assessment and diagnostic practices for ASD in Mexico is of particular importance for professionals practicing in the U.S. as most immigrants in the U.S are from Mexico therefore it is likely professionals in the U.S. will encounter patients on their caseloads that received diagnoses of ASD in Mexico.

Health Profession Student’s Readiness Towards Online Learning as a Component of Blended Learning

Objectives: The objectives of this study were to identify the entry-level health profession students’ perception and readiness to adopt online learning as a component of blended learning (BL). Methods: A cross sectional survey using a structured questionnaire was administered using Google forms. Entry level Health professionals’ education (HPE) graduate students of a higher education institute in India completed the survey (N= 628). The questionnaire was developed from the literature and content validated by experts. Ethics clearance was obtained from the Institutional ethics committee. Results: Out of 628 responses, 603 fully completed questionnaires were included for analysis. Of the participants, 98 % owned a smartphone, whereas 67% possessed either a laptop or a stationary computer. 60 % of the respondents reported at least one hour of internet access per day for learning purposes. Most of the participants were comfortable in accessing online learning materials and interacting with peers. The majority of the participants (77.4%) were willing to spend 10 to 20 hours per week on online learning. Conclusion: Entry Level HPE graduate students were ready to adopt online learning as a component of BL. Providing necessary infrastructure and creating online learning materials needs to be considered.

Remote Job Application Simulation Using Technology in Athletic Training Students: A Preliminary Teaching Technique

While athletic training students go through extensive preparations for engaging with patient populations as healthcare providers, less time is spent on preparing athletic training students on how to secure employment after graduation. Without proper employment skills development, securing employment can pose a challenge for the athletic training student trying to enter the workforce. These skills include developing cover letters and resumes, and remote interviewing skills. Purpose: The purpose of this paper is to explore the preparations, execution, and lessons learned from a simulated, remote job application and interview process for athletic training students. Methods: This educational technique was performed using certified athletic trainers as interviewers and reviewers of job application materials (i.e., cover letter, resume, and application email) created by athletic training students. Athletic training students were interviewed by a certified athletic trainer with whom they had no previous relationship. After the structured interview process, a debrief was conducted between the certified athletic trainer and athletic training student. The process was conducted via Zoom. Results: By using simulation techniques, athletic training students are able to experience a realistic review of their cover letters and resumes and engage in a realistic, remote job interview in a low-stakes environment with real-time, objective feedback. Conclusions: Overall, athletic training students' reflections indicate the utility of the experience through interviewer observations, introspective observations, and overall thoughts on the experience. The faculty also identified ways to improve the experience in subsequent years.

Characteristics Needed to Transition from Exemplary Clinical Instructor to Successful Site Coordinator of Clinical Education: A Qualitative Study

Introduction: In physical therapist (PT) education, the site coordinator of clinical education (SCCE) administers and manages clinical placements for student clinical education experiences from the clinical side. Characteristics of successful site coordinators of clinical education (SCCEs) have been established; minimal evidence informs the identification of individuals with those characteristics. One cannot assume that exemplary clinical instructors (CIs) will become effective SCCEs. Purpose: The purpose of this qualitative study was to investigate if the characteristics of exemplary CIs are consistent with the traits needed in a successful SCCE candidate by exploring these 3 aims: (1) Describe characteristics of exemplary CIs. (2) Identify characteristics needed to fulfill the SCCE position. (3) Determine if exemplary CIs are well-suited to transition to the SCCE position. Methods: SCCEs and exemplary CIs participated in one-on-one interviews. Inductive and deductive methods were employed and triangulated to provide multiple sources of data to examine the research questions. Results: Exemplary CIs (n=12) demonstrate excellence and commitment to clinical education. These natural leaders “pay-it-forward.” SCCEs (n=12) demonstrate commitment to clinical education, professional drive, and strong managerial and leadership skills. Transitioning from CI to SCCE involves a significant learning curve, and participants agreed that “you have to want it.” Conclusion: While exemplary CIs have the characteristics needed to become a successful SCCE, they should carefully consider its demands. SCCEs should be recruited based upon assessment of aptitude, not longevity or seniority. Ultimately, every SCCE should be an exemplary CI, but not every exemplary CI is prepared to be an SCCE. These findings may apply to individuals serving in similar roles across health professions.

The Predictive Relationship Between Psychological Capital and Academic Burnout in Postgraduate Students

Purpose: The purpose of this quantitative correlational study was to determine if, or to what extent, the composite and sub-composite categories of Psychological Capital (PsyCap) predict academic burnout in American postgraduate health science students at a university in the Southeastern United States. Methods: The variables of the study were measured by the Psychological Capital Questionnaire (PCQ-24) and the Maslach Burnout Inventory-Student Survey (MBI-SS). A convenience sampling method was used to collect data from the target population, which included a final sample of 90 health science postgraduate students. Results: A simple linear regression analysis revealed that PsyCap was a significant and negative predictor of academic burnout (F(1,88) = 12.00, p < .001, R2 = 0.12; B = -0.28, t(88) = -3.46, p < .001). Additionally, multiple linear regression analysis revealed that only one sub-category of PsyCap, labeled as Optimism, was a significant and negative predictor of academic burnout (F(4,85) = 5.17, p < .001, R2= 0.20; B = -0.90, t(85) = -3.17, p = .002). Conclusion: The findings may be used by higher education instructors, advisors, and administrators in the United States to adopt policies, practices, programs, student advising, and student mentorship that foster PsyCap and Optimism development in students, which may mitigate the risks and consequences of academic burnout.

Adolescent Athletes’ Perspectives on the Social Implications of Sport-Related Concussion

Purpose: Sport-related concussion can affect many domains of a patient’s health status. Social functioning is an important consideration, especially for adolescent athletes. Our purpose was to explore adolescent athletes’ social perspectives regarding sport and concussion. Methods: Using a qualitative study design we interviewed 12 interscholastic athletes who had sustained a sport-related concussion. The interviews focused on injury details, and explored the physical, psychosocial, emotional, and spiritual components of sport and health. Themes and categories were identified using the consensual qualitative research process by a three-person research team. A comprehensive codebook that captured the main themes and categories resulted. Results: Following concussion, participants discussed two primary themes: perceptions regarding the social aspects of sport and social perspectives regarding their concussion. Specific categories related to the social aspects of sport included: friendships and family and decision to participate based on peers. Specific categories regarding the social perspectives of the concussion included uncertainty of the diagnosis, perceptions of others regarding their injury, being ashamed of the concussion, parent and peer roles, and communication and expectation about their concussion. Conclusions: Participation in sport and removal from sport following a concussion have significant social implications for adolescent athletes. Specifically, the perceptions of peers, parents/guardians, and others regarding the injury can influence reporting of symptoms and recovery following concussion. Limited communication regarding recovery and expectations post-concussion may cause undue social pressures to return to activity prematurely. Providing a supportive environment in which patients can recover from concussion while engaging with peers and teammates is important. Anticipatory guidance, with education regarding the possible signs and symptoms, risk factors pre- and post-injury, and recovery expectations following a concussion are important to include in post-injury management and should be known to all stakeholders.

Development of a Digital Health Capability Framework for Allied Health Practitioners: An Australian First

Background: The value of digital health technologies and their contribution to high-quality and safe clinical care and enhanced health patient experience and outcomes is well established. Digital health technologies are increasingly being used by Victorian allied health professionals (AHPs) in routine service delivery, the uptake of which has been significantly accelerated by the impact of the coronavirus (COVID-19) pandemic. Objectives: This case study outlines the development of a capability framework to support Victorian AHPs, health services, other employers, and university training partners to measure and expand digital health capability at individual practitioner and workforce levels. Methods: A mixed-methods approach to the development of digital health and clinical informatics capabilities and the resultant framework is described, consisting of five phases: (i) a literature/scoping review to identify existing frameworks (ii) expert panel interviews, (iii) thematic analysis of interview themes, (iv) user testing and feedback and, (v) revision based on feedback. Results: This approach proved successful in managing key challenges that emerged during the project, as well as identifying potential barriers and enablers to longer term framework adoption, implementation, and maintenance. Conclusion: This study describes a mixed-methods approach to the development of an Australian-first, Allied health digital health capability framework to address knowledge and skills development at individual practitioner and workforce levels. This case study highlights the need for targeted education and training resources to support the health workforce to build capability in the application and use of digital health technologies. In developing a digital capability framework specific to the allied health workforce, the importance of stakeholder consultation in the early identification of barriers and enablers to potential uptake and implementation is also reinforced.

Comparative Effectiveness of Jade Stone Mobilisation, Non-Abrasive Cupping, and Manual Drainage Technique in Subjects with Chronic Sinusitis: A Randomized Clinical Trial

Purpose: Sinusitis in recent times has been known as one of the major causes for reduced quality of life and work absenteeism. Chronic sinusitis being one of the health hazards affecting QOL of subjects of any age and gender requires a specific therapeutic intervention. Clinical trials that can demonstrate the effectiveness of manual therapy intervention in sinusitis cases are lacking. Hence, this study aims to evaluate and compare the effectiveness of three manual therapy techniques in subjects with chronic sinusitis. Method: The current study is a prospective, parallel arm, randomised clinical trial performed at physiotherapy OPD, tertiary health centre, Belagavi. Forty-five subjects who had chronic sinusitis were randomised and allocated into three different manual therapy groups with 15 subjects each study group. Sample size was calculated using the formula n= Sd2[Zα + Zβ]2/d2 where α value was set at 1.96 and β was set at 0.842. Both male and female subjects between 18-45 years of age with chronic sinusitis for more than 3 months were included in the study (with 1 dropout due to loss to follow-up). Subjects in group A received jade stone mobilization, group B received non-abrasive cupping, and group C received manual drainage technique for 3 times a week for 2 weeks with a follow-up at the 6th week from the baseline. As an outcome measure pressure algometer and SNOT-22 questionnaire were taken to assess pressure pain threshold and quality of life of sinusitis subjects respectively. Results: The results showed significant improvement between and within all the three study groups post 2 weeks of intervention in terms of pain pressure threshold and quality of life. However, at 6th week follow-up, the jade stone group showed greater improvement than the other two groups. Conclusion: The study concluded that all the three manual interventions are safe and effective manual therapy techniques to treat the cases of chronic sinusitis.

The trial was prospectively registered under the clinical trial registry of India with trial number CTRI/2020/10/028321.

The Feasibility and Efficacy of Telespirometry for Pulmonary Monitoring of Cystic Fibrosis: A Systematic Review

Background: Spirometry via telehealth (telespirometry) involves remote monitoring of lung function, which is useful to detect pulmonary changes and increase continuity of care for patients with cystic fibrosis (CF). Purpose: This systematic review aims to evaluate the feasibility and efficacy of telespirometry assessments for paediatric and adult CF patients. Method: A comprehensive search of health-related databases (CINAHL, Emcare (Ovid), Medline (Ovid), PEDRo and Scopus) was conducted. For inclusion, patients had to be clinically diagnosed with CF and studies could be of any study design or level according to the National Health and Medical Research Council (NHMRC) evidence hierarchy, had to use telespirometry devices for lung function tests, and be written or translated into English. The Crowe Critical Appraisal Tool (CCAT) was used to assess study quality, while also accounting for potential sources of bias encountered during the review process. Data was exported and summarised using the population, intervention, comparators, and outcomes (PICO) framework in Microsoft excel, to provide clinical recommendations. Results: Fourteen studies were included, with participants ranging from 5 to 44-years-old. Thirteen trials were performed domestically, while sample sizes and baseline patient characteristics varied. Nine studies analysed a control and intervention group. All studies varied in the intervention regime and clinical support provided. Collectively, the literature indicated poor patient adherence to telespirometry, which acted as a barrier to gauging its efficacy. Although appearing to be effective in detecting pulmonary deterioration, inconsistencies in pulmonary exacerbation (PEx) criteria were identified and lack of significant improvements in pulmonary outcomes were observed. Conclusion: Poor quality literature and small sample sizes increased risk of bias and restricted the application of the results to clinical practice. The current evidence base is limited by minimal experimental studies, lack of standardised telespirometry protocols, and criteria for PExs and poor patient compliance. Recommendations: At this stage, telespirometry for CF monitoring should be used by motivated and rurally/remotely located patients to complement in-person consults until its uptake is improved and accuracy and clinically efficacy can be ascertained.

Socioeconomic Inequalities in Self-Perceived Oral Health Among College-Going Students in Karachi, Pakistan

Background: Oral health inequalities are becoming a major threat to public health, and they excessively burden disadvantaged communities, especially within low and middle-income countries. This study explored the socioeconomic inequalities in self-perceived oral health behaviors among college-going students in Karachi, Pakistan. Methods: A cross-sectional study was conducted among 328 college-going students using a convenient sampling technique from three different socioeconomic groups including urban slums, middle, and rich class neighborhoods. Oral health was assessed using three measures: daily tooth brushing, weekly sweet consumption, and substance abuse. Socio-economic inequalities were measured using binary logistic regression (odds ratios), relative index of inequality, and slope index of inequality. Results: Out of 328 participants, 56.4% perceived their oral health as fair, 24.1% good, 14.9% poor, while only 4.6% had an excellent perception of oral health. Significant inequalities were found regarding oral health behaviours with fraternal income, occupation, and education level. Education-related absolute inequalities among college-going students were1.28(95% CI -2.19, -0.36 p-valueConclusions: In Pakistan, data among college-going students regarding oral healthcare is scarce. Significant inequalities were found in oral health behaviours among college-going students. Thus, there is a need to design equity-based health system provisions specifically to address the needs of poor segments of society.

Impact and Experiences Relative to Critical Incidents and Critical Incident Stress Management

Purpose: Typically, athletic trainers (ATs) have relied on external support networks to debrief after a critical incident (CI). ATs report focusing on improving work-related processes after a CI rather than their emotional response to the CI. The purpose of this study was to identify both the short-term emotional impacts of CIs and what coping strategies ATs use to address their emotional response to CIs. Methods: We used a cross-sectional, web-based survey, distributed to a random sample of NATA members to explore the perceived effects of CIs on ATs. Participants (n=73, 36±11y) were primarily women (n=53, 72.6%), working in the college/university practice setting (n = 40, 54.8%), with 7±3y of experience. All participants experienced a CI within the previous 12 months. The data were analyzed using descriptive statistics for demographic variables and multi-analyst inductive coding for the open-ended items amongst a 4-person team. We used a modified consensual qualitative research (CQR) process to review and analyze the open-ended questions and identify domains and core ideas. Trustworthiness was established with multi-analyst triangulation and auditing. Results:  Participants most commonly reported feelings of thinking too much (71%, n=52), anxiety (63%, n=46), sadness (60%, n=44), fatigue (53%, n=39), and sleep disturbance (49%, n=36) resulting from CIs. Common coping strategies used were exercise (63%, n=46), humor (44%, n=32), interacting with pets (41%, n=30), expressing oneself through crying (40%, n=29), and peer support (34%, n=25). Sixty-two participants (86%) responded to open-ended questions related to the outcomes of CIs. Four domains were identified from the open-ended responses. Those domains included 1) dissociation, 2) deteriorated emotional state, 3) disruption of daily activities, and 4) improved event or post-event processes. Conclusion: Various strategies are used by ATs to cope with CIs; however, the only ways in which ATs expressed that coping helped was with care delivery, not the emotional impact of the CI. The lack of responses relative to coping strategies that improve quality of life is potentially alarming. To build resilience and persistence, organizations should consider requiring support beyond process improvement that addresses the emotional impact of CIs.

A Survey of Interventions for Cancer Survivors Provided by Occupational Therapy Practitioners

Purpose: Currently, there is a lack of research exploring evidence-based occupational therapy intervention practices at the activity level in survivorship care, which is important to identify for future research and clinical needs of the profession. The purpose of this study was to describe what activity level interventions OT practitioners are using and report any practice trends that might exist. Method: A cross-section design was used with non-probability purposive sampling to recruit occupational therapy practitioners working with adults living with and beyond cancer. A three-phase process for survey development and implementation was used, as recommended by the literature, for improving content validity and minimizing measurement error. Results: A total of 267 surveys were distributed and 70 surveys returned (26.20% response rate). Given the range and frequency of responses, it is suggested that occupational therapy practitioners focus on individual needs for function and participation and are not limiting practice to physical impairments. There were several areas that only a small percentage of respondents identified addressing with clients, including shopping (range 5.83-9.23%), driving and community mobility (range 5.90-9.58%), and financial management (range .74-10.20%) that typically fall into outpatient and community health practice settings. Conclusion: We reviewed current oncology intervention and referral practice trends for occupational therapy and pose several implications for advancing clinical practice in oncology. Future research into interventions not supported by literature that occupational therapists identified currently using in practice is needed.

State-Trait Anxiety and the Relationship with Patient Outcomes Following TKA

Purpose: To analyze the relationships between state (S) and trait (T) anxiety and functional outcome measure performance in patients following total knee arthroplasty (TKA) receiving physical therapy (PT). Methods: Nineteen patients (62.7±9.9 years) who recently underwent TKA completed testing post-TKA and at discharge that included the modified Lower Extremity Functional Scale (mLEFS), Numeric Pain Rating Scale (NPRS), State-Trait Anxiety Inventory (STAI), Pain Catastrophizing Questionnaire (PCQ), knee range of motion (ROM), thirty-second chair stand test (30s-CST), and the timed up and go (TUG) test. Additionally, NPRS, ROM, 30s-CST, and TUG measures were taken at three and five weeks following TKA. Results: Baseline S- and T-anxiety correlated highly with baseline PCQ (ρ= .546-.676, p= .001-.016) and the 30s-CST (S-Anxiety ρ= -0.531, p= .019). Baseline S- and T-anxiety revealed strong correlations with discharge PCQ scores (S-anxiety ρ= .462-.536, p= .018-.046). The discharge S- and T-anxiety surveys also correlated with discharge measures of mLEFS (ρ= .606-.675, p= .002-.006) and NPRS (ρ= .588-.707, p= .001-.008). Conclusions and Recommendations: This study of S- and T-anxiety and its effects on outcomes following TKA procedures revealed patients’ pain, ROM, and functional outcome measures improved, while S-anxiety, T-anxiety, and PCQ scores had no significant changes from baseline to discharge. Knowing this, clinicians could be proactive and incorporate relaxation techniques, stretching, and massage as a standard means of care.

Pain Education Training in New York State Physical Therapy Programs: What We Do Well, Where the Gaps Are, and What Can Be Improved

Purpose: Essential pain education produces graduates who are competent in contemporary pain management. Despite various educational resources, surveys demonstrate minimal pain content in entry-level physical therapist education programs. This paper examines 1) the learning content of pain education and faculty expertise teaching core pain content, 2) whether pain education content is sufficient to prepare physical therapists to meet the needs of contemporary pain management, and 3) whether standardization of pain education in entry level Doctor of Physical Therapy (DPT) programs is advantageous. Methods: A pain education survey was developed and sent to all accredited DPT program directors in New York State. The survey included questions related to content and hours devoted to teaching 1) pain science, 2) pain education, 3) psychosocial factors, 4) biopsychosocial model, 5) cognitive-behavioral techniques, 6) advanced faculty training, and 7) challenges adding pain education to the curriculum. Results: In total, 10/15 programs responded. (1) 60% reported they do not have a class dedicated to pain science, (2) 60% reported < 10 hours of pain education (3) 60% reported a class on psychosocial factors, (4) 50% reported < 10 hours on the biopsychosocial model, (5) cognitive- behavioral techniques varied between 10-30 hours, (6) 70% of faculty received advanced training, and (7) challenges to adding pain education included time, a dense curriculum, and pain content is not part of NPTE exam questions. Conclusions and Recommendations: New York State accredited DPT programs include pain education, although content, time, and methods vary greatly. Increased standardization for pain education would create consistency across all U.S. DPT programs. Based on the findings from the study, an investigation should be undertaken to determine if more specific standards for pain education are advantageous for the entry level DPT curricula.

Investigating Doctor of Physical Therapy Student Stress During Pandemic Related Curricular Changes

Introduction: Stress level in physical therapy students has been a focus of research due to multiple documented effects related to physical health, mental health, and ability to learn. Self-reflection has also been a focus of education research, relating it to personal learning, critical thinking, and demonstrable development of professional behaviors and skills. The aim of this study is to investigate student stress in response to programmatic changes wrought by the pandemic and whether stress impacted student self-reflection. Review of literature: Self-reflection is positively associated with growth of professional behavior and academic performance. Student level of self-reflection has been shown to be negatively impacted by stress. Subjects: A convenience sample of 35 students entering the program fall 2019 made up the participants. Methods: Outcome measures were collected six times over two academic years. The Self-Reflection Insight Scale (SRIS) consists of 20 statements rated on a 5-point Likert scale with 3 subscales: need for reflection (N), engaging in reflection (E), and insight (I), scoring from 10 to 100. The Perceived Stress Scale (PSS-10) is a 10-item questionnaire rated on a 4-point Likert scale, scoring from 0 to 40. Results: SRIS scores increased significantly from time 1 to 2, prior to the campus closure; no significant change for times 3 through 6. PSS scores indicated a higher percentage of students reporting a high level of stress at time 3 in the months after campus closure, decreasing significantly from time 3 to 4 during virtual/hybrid learning and increasing from time 5 to 6 as students prepared for clinical internship. No correlation was seen between SRIS and PSS, however a negative correlation was observed between SRIS subscale I and PSS at time 4 and 5. Discussion: Student perceived stress decreased during the study despite a universally stressful time. Student stress increased as students prepared for their first clinical internship experience, consistent with prior research. Initial gains in student self-reflection did not significantly change during the 1.5 years of the pandemic indicating that despite multiple academic and social challenges, students were able to maintain, but not grow, their level of professional self-reflection. Research is needed to further describe the relationship between stress and insight. Conclusion: The Program’s response to pandemic mandates may have positively influenced student stress.

The Effect of Tai Chi on Dynamic Balance in Younger Adults: Implication for Physical Therapy Practice

Purpose: The objective of this study was to investigate the effect of Tai Chi on the dynamic balance in younger, active community-based adults with no history of lower extremity injury or balance problems. Methods: Fourteen subjects (4 males / 10 females; age 23.6 + 6.2 years-old; height 166.5 ± 11.1 cm; weight 75.9 ± 19.3 kg) completed a 13-week undergraduate Tai Chi course. Dynamic balance was assessed at the beginning and the end of the course using the Y-Balance test. Results: Post-hoc testing showed significant improvements in anterior (P=0.007) and posterior lateral (P=0.003) reach distances with a Cohen’s d at 0.54 and 0.71 for the anterior and posterior lateral, respectively with significant improvement in right composite compared to left composite (PConclusions: These findings suggest that Tai Chi may be useful as an exercise regimen to increase anterior and posterior lateral dynamic balance in balance-dependent activity as measured by the Y Balance Test. The authors champion that Tai Chi may be a useful addition for a physical therapy treatment plan, preventative exercise plan, or wellness program to increase anterior and posterior lateral dynamic balance.

Development, Implementation, and Delivery of a Remote Burnout Prevention Elective Course in an Accelerated Doctor of Pharmacy Program During COVID-19

Purpose: There is limited evidence describing burnout among graduate health professions students, including pharmacy students, and there is a need for educational institutions to mitigate burnout and promote future healthcare provider wellness. Methods: A burnout prevention elective course was developed within an accelerated Doctor of Pharmacy program. Course faculty transitioned from live to fully remote instruction in April 2020. The modified course format combined discussion-based lectures, burnout self-assessments, reflective writing assignments, and applications-based presentations. Results: Twenty-one second-year pharmacy students completed the elective, and 13 completed post-course evaluations (61.9% response rate). Evaluations indicated substantial student support, with 92.3% “strongly agree” and 7.7% “agree” responses for all questions. Students suggested incorporating this course into the core didactic curriculum rather than offering it as an elective. Conclusion: Pharmacy programs considering piloting similar courses may effectively implement them even under the modified learning conditions imposed by COVID-19.

A Survey of Human Gross Anatomy Laboratories in DPT Programs across the United States

Purpose: The purposes of this study were to 1) describe the current teaching methodology used in Doctor of Physical Therapy (DPT) human gross anatomy (HGA) labs, 2) examine the demographics and perceptions of HGA instructors and compare responses based on years of experience, 3) determine the utilization and instructor perceptions related to cadaver dissection and other methods of instruction, and 4) determine which safety/security protocols are used in HGA laboratories. Method: All DPT programs (N=250) in the United States (US) accredited by the Commission on Accreditation of Physical Therapy Education (CAPTE) were eligible to participate. The anonymous, 89-item online survey was completed by either an HGA instructor or DPT program director in March of 2020. Seventy-four individuals responded for a response rate of 29.6%. Results: Respondents represented programs from 65.2% private and 34.8% public institutions. Fifty percent of respondents dedicated 31-60% of their HGA course to face-to-face lab time, with 68% reporting an instructor to student ratio in lab of 1:15 or smaller. Seventy percent of instructors were US licensed PTs, and 78% of those PTs held an academic doctorate. The average years of anatomy teaching experience was 11.3. Ninety-six percent of programs utilized cadavers. Most programs (86%) had students perform hands-on cadaver dissection. Overall, 90% of instructors incorporated learning activities into lab beyond dissection. Ninety-four percent of instructors reported enjoyment teaching HGA, and a majority felt they had adequate teaching support and academic preparation. Sixty percent of respondents felt that cadavers were the only way to teach lab, while 90% felt that cadavers were the best way to teach lab. Regarding safety, 38% of instructors had concerns regarding chemical exposure in lab, and 11% believed their health was at risk. Comparative analyses found significant differences in instructor perceptions based on years of anatomy teaching experience (+/- 10 years). Less experienced faculty were more likely to believe that a non-cadaver approach to teaching HGA can be as effective as using cadavers given the right technology, while more experienced faculty were more likely to believe that teaching HGA with cadavers was the best way to teach lab. Conclusions: DPT program directors and instructors may find this study valuable to compare their HGA course(s) to other programs in the US. Although there is a clear preference for including cadavers in HGA laboratories, it is evident that most instructors are incorporating other learning approaches in their HGA laboratories.

Access, Engagement, and Experiences with Critical Incident Response Resources in Athletic Training

Purpose: Experiencing an event that involves actual or threatened death or serious injury is a critical incident and produces serious emotional responses. Athletic trainers (ATs) experience critical incidents in their day-to-day work. The purpose of this study was to explore how ATs experience a critical incident during the course of clinical practice. Methods: We used one-on-one, web-based, semi-structured interviewing with a criterion sample of ATs who experienced a critical incident and used any critical incident response resources in the last year (n=17; age=32±8; years of experience=9±7; years in current position=4±5). We used a 3-person team with a multi-phase process to identify the emerging domains and categories. Results: Two emergent domains were identified from the study. External support referenced multiple personnel resources available after a critical incident occurred, specifically, trained mental health professionals, untrained personnel, and trusted colleagues/coworkers. Coping with the emotional response included debriefing, spirituality, and complementary mental health strategies. Conclusion: In preparation for critical incidents, emergency action planning and after-action planning for healthcare delivery and the emotional response are both essential. Many ATs do not have the formal training, but continuing education courses, community-based mental health resources, and the promotion of professional organization resources can assist ATs in critical incident management.

Effectiveness of Interprofessional Education Modules on Cultural Competency of Physical Therapy and Occupational Therapy Students

Purpose: The United States is a melting pot of diverse ethnicities and cultures. Graduate-level teaching methods must prepare students to work with diverse populations and in various contexts. The outcome of instruction should be technically competent and culturally humble health care providers. The purpose of this study was to investigate the effectiveness of collaborative interprofessional instruction on cultural competency levels of Doctor of Physical Therapy Program (DPT) and Master of Science Occupational Therapy Program (MSOT) students. Methods: This was a pre-posttest quasi experimental study. A total 58 students from the DPT (28) and MSOT (30) programs participated and provided demographic information for this study. Cultural competency levels of the students were determined at the beginning of their first year and prior to graduation. The paper version of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals - Revised (IAPCC-R) was used to assess cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. Instructional methods included: webinars, implicit bias assessments, self-reflection, class interactions, and an interprofessional student panel discussion. Paired t and Multiple mixed-design ANOVA tests were used to compare the pre-instruction and post-instruction cultural competency scores and to compare key demographic characteristics. Results: Post-instruction cultural awareness, knowledge, skill, and total scores of the IAPCC-R were statistically significantly higher than pre-instruction scores (p0.05). Between group comparisons revealed that female and male students showed similar improvements on total and all subscales of the survey (p>0.05). Caucasian students showed greater improvements on cultural skills and encounters subscales than minority students (p0.05). Conclusion: Collaborative interprofessional cultural competency focused instruction is effective in improving cultural competency levels of healthcare DPT and MSOT students. Healthcare professional programs should consider the benefits of interprofessional education in areas such as cultural competency/humility. The efficacy of the instruction on a topic such as cultural awareness/humility/competence should have quantifiable and qualitative outcome measures to determine the benefits of the instruction, monitor students' progress, and provide a rationale for content inclusion in curricula.

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Using the Unfolding Case Study to Improve Clinical Reasoning

Context: When authentic clinical experiences are unavailable, instructors may need to consider alternatives for evaluating clinical reasoning. Objective: Describe an educational technique that simulates clinical experiences to allow students to demonstrate clinical reasoning. Background: The COVID-19 pandemic created a situation where providing clinical experiences became impossible. Yet, students still needed to exercise clinical judgement as part of their athletic training education program. The unfolding case study technique aligns well with Kolb’s Theory of Experiential Learning and can be used to help students improve clinical reasoning and critical thinking skills. Description: An unfolding case study was used to simulate a clinical experience for students when clinical sites became unavailable to students due to COVID-19. The technique involves using a case study over time where the student receives information, evaluates the information, makes a clinical decision in response to the information, and receives further information and feedback based on their decision. This repeats until the student reaches the conclusion of the case. Clinical Advantages: Students found this assignment to be beneficial as it allowed them to practice clinical reasoning and critical thinking in a realistic, yet low risk environment. Students were able to learn new skills in documentation and billing for services. The assignment allows for critical feedback to be given to the students at multiple points. Conclusions: The unfolding case study can be an effective substitute for a clinical experience in extreme situations. The unfolding case study allows students to exercise clinical judgement in a safe environment.

Attitude and Barriers to Participation in Research Among Physiotherapy Interns in Nigeria

Purpose: This study is meant to assess the attitude and barrier towards research in physiotherapy interns of Nigeria. Method:  A WhatsApp-based cross sectional online survey was conducted using an e-questionnaire (Google form). The link was sent to corresponding intern from each training institution in Nigeria. Frequency, percentages, means, standard deviation and ANOVA or t test were used to analyse the data in SPSS version 20 at alpha level 0.05. Result: The majority of the participants were male (73.2%) within the age range of 26-30 years (53.6%) and undergoing the training in northwestern part of the country (48.2%). Though the majority of students have undergraduate training on research, only few are currently involved in research. The participants have positive attitudes (4.11), see great barriers (3.37) and have had a good experience with research (2.70). Conclusion and Recommendation: Participants reported a positive attitude towards the effect of research as the majority strongly believe in its professional enhancement and improvement in patient’s care. However, barriers such as lack of financial support, incentives, mentorship, and sufficient time were found to be great challenges towards conducting research.

Clinical Reasoning in PTA Students: A Survey of PTA Program Directors

Purpose: The purpose of this study was to investigate the perspectives of program directors of CAPTE accredited physical therapist assistant (PTA) educational programs on clinical reasoning (CR) in PTA students and the applicability of the Integrated Clinical Education Theory (ICET) to clinical reasoning in PTA students through exploratory research. Methods: Participants completed a survey that collected information about demographics and PTA program directors’ perspectives on qualities of clinical reasoning and on the concepts of the ICET. Descriptive statistics and directed content analysis were used to analysis participants’ responses to Likert scale questions and open-ended questions, respectively. Results: Three hundred and seventy PTA program directors were emailed a questionnaire and 97 participated. Participants indicated that clinical reasoning is an important skill for PTA students to develop and perceived that the ICET concepts are an important component in clinical reasoning development. Perceptions of clinical reasoning also aligned well with the definition of clinical reasoning associated with physical therapy students. Conclusion: Clinical reasoning is an important skill that should be developed in PTA students. The ICET framework can potentially serve as the foundation for the development of clinical reasoning in PTA students.

The Rationale Behind and Impact of One Hospital’s Provision of Secondary School Athletic Training Services: A Five-Year Case Study

Purpose: Sports-related injuries are common and often require physician or hospital care. Since the advent of concussion laws in fifty states, hospitals across the country have come forward to partner with secondary schools in the provision of sports medicine healthcare. The outreach agreements are consistent: Hospitals hire athletic trainers (ATs) and then outsource them to schools. ATs help mitigate risk in sports programs. Onsite at the schools daily, ATs provide immediate evaluation and treatment for injuries that occur and render decisions regarding the appropriateness of an injured athlete’s return to participation. The goal of this case study was to describe the experiences of one hospital in relation to (a) the factors the contributed to its administration’s decision to provide athletic training services to area schools, (b) the program structure, (c) the annual costs, and (d) the benefits reaped. Methods: This investigation spanned the course of the first five years of the hospital’s partnership with four separate high schools. Interviews with key hospital and school district administrators along with additional tracking of the number of professional medical referrals helped to illuminate the program’s successes. Results: The partnership proved to be a win-win. It strengthened the hospital’s community relations, provided area school sports programs with much-needed medical oversight, and provided a consistent stream of revenue generation via professional medical referrals, both for the hospital and for its affiliated providers. Conclusion: Hospital administrators should look to this example as one that supports the decision to partner with local schools in the provision of athletic healthcare.

Job Performance of Healthcare Providers Working in Public Sector Hospitals in Pakistan

Purpose: This study sought to explore the job performance (JP) of health care providers (HCPs) working in public sector hospitals in Pakistan. Methodology: A descriptive cross-sectional study was carried out in Liaquat University Hospital, Hyderabad, and Jamshoro, Sir Cowasjee Institute of Psychiatry, Hyderabad, and Shah Bhittai Hospital, Hyderabad. A three-sectioned questionnaire containing the socio-demographic characteristics information regarding the job and an individual work performance questionnaire to measure job performance was used. The relationship between different job-related study variables and job performance was sought by applying a one-way ANOVA test at a p-value of 0.05. Results: Results on the job performance scale revealed that 60.6% of doctors had satisfactory performance, and only 39.4% had an unsatisfactory job performance. Job performance differs significantly by age (F2, 357=3.259, p2, 357=3.583, p1, 358=5.217, p1, 358 =1.819, p>0.05), income (F2, 357=1.642, p>0.05), beds under supervision (F4, 313=1.400, p>0.05), current organizational tenure (F3, 356=1.576, p>0.05), healthcare experience (F3, 356=1.363, p2, 357=0.381, p>0.05), weekly off days (F1, 358=0.421, p>0.05) and dual practice (F1, 358=1.700, p>0.05) have no significant effect on levels of job performance of the employee. Conclusion: Job performance was satisfactory and significantly associated with variables such as age, difficulties faced by respondents at work, and the number of patients treated per day.

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Digital and Musculoskeletal Health Literacy of Collegiate Student-Athletes

Purpose: To assess the digital health literacy (DHL) and musculoskeletal health literacy (MHL) levels of collegiate student-athletes. Methods: We used a cross-sectional survey to assess collegiate student-athletes (n=160) health literacy using the Digital Health Literacy Instrument (DHLI) and Literacy in Musculoskeletal Problems (LiMP) tool. Data were analyzed using descriptive statistics. Results: The majority of participants shared they accessed the Internet via smart phones and felt the Internet was important and useful to their health. On average, the participants scored a 3.36±0.38 on the DHLI. The LiMP score was 6.29±1.36, and 26.8% (n=15/56) of participants who completed the tool had limited or inadequate MHL. Conclusions: Most student-athletes possess adequate DHL and MHL. The findings directly impact patient education as student-athletes are using their phones to access health related information, which they feel comfortable with, but may not know if the source is trustworthy.

Whey Versus Casein Supplementation in Physically Active, Healthy Individuals

Purpose: Research shows the benefits of whey isolate protein powder and casein protein powder supplementation in regard to body composition and resting metabolic rate; however, minimal research exists comparing the effectiveness of whey to casein supplementation. Methods: Eighteen (18) physically trained, healthy individuals (23±3.1 yrs.; 171.7cm; 12 males; 6 females) completed a randomized two condition [Combat 100% Isolate (Whey) versus Combat 100% (Casein)] by two time point [Pre-, Post-] intervention. The intervention consisted of subjects supplementing on either whey or casein in conjunction with resistance training over an 8-week period. Pre and post testing included % body fat and metabolic rate. Results: A 2x2, repeated-measures analysis of variance (ANOVA) demonstrated non-significant (p ≥ 0.05) effects on changes in % body fat and resting metabolic rate following the 8-week intervention. Conclusions: The data concludes no differences in the effects of whey versus casein protein supplementation in physically active, healthy individuals

Comparison of Survival Rates Between Two Cardiopulmonary Resuscitation Protocols and the Association of Crew Consistency

Background: Cardiac arrest is a life-altering event that requires swift, coordinated actions from numerous individuals for patient survival. Although return of spontaneous circulation is the goal of every emergency medical service agency, survival rates continue to be low due to many factors. Many variables are out of direct control of emergency medical service agencies, but some, such as protocol development and personnel training, are well within their power. Purpose: The purpose of this mixed-methods study was to examine the new HP-CPR protocol implemented by a large southeastern urban fire rescue department to see if changes to existing protocol assisted, in any way, with an increase in ROSC rates. The study also looked at group dynamics and whether crew consistency and well-defined positions played a role in patient survival. Operations personnel views and attitudes on the new protocol and importance of well-defined roles and consistency during a stressful event such as cardiac arrest were also investigated. Their input could shed light on other areas needing further research or improvement such as bystander intervention improvement strategies, response and on scene times, and location of arrest. Methods: This mixed-methods study evaluated the effectiveness of a protocol change in a large southeastern urban fire rescue department. It examined cardiac arrest incidents involving adults 18 years and older. The study compared survival rates between the previous protocol and the new high-performance cardiopulmonary resuscitation protocol, also known as pit crew cardiopulmonary resuscitation. It also examined whether crew consistency impacted survival rates and gathered crew perceptions of the new protocol and crew dynamics. Results: The results of the study provide evidence of effectiveness of the new protocol, areas for improvement, and whether group dynamics played a role in patient survival during out-of-hospital cardiac arrest. Conclusions: The results could guide future protocol development and provide a template for other agencies to follow that are experiencing low survival rates.

College/University Independent Medical Care in the COVID-19 Era

Purpose: Legislation was created for NCAA Divisions I, II, and III to guarantee an independent medical care administrative structure designed to give “unchallengeable autonomous authority” regarding diagnosis, management, and return to play decisions to primary athletics health care providers (physicians and athletic trainers). The purpose of this project was to 1) explore the structure of athletic health care in NCAA athletic institutions as it relates to independent medical care, and 2) describe changes in those structures that have occurred as a result of the COVID-19 pandemic. Methods: We used a cross-Sectional Study. Setting: College/University. In 2017, 162 supervising athletic trainers responded to our survey. Variables collected included health care delivery model, AHCA selection, decision making and injury reporting structure, confidence in independent medical care, COVID-19 response involvement, changes due to COVID-19. Results: The overall demographic characteristics indicated that most supervising athletic trainers were male (117/162, 72.2%), 48 ± 10 y old, and have been at the institution for a significant tenure 15 ± 11y. In 2020, responses from 174 supervising athletic trainers were recorded in the survey. The majority of respondents were male (108/174, 62.1%). Average age of the population was 45 ± 11y with 22 ± 10y of experience and 15 ± 10y of experience at their current institution The athletics health care model is most common across all NCAA Divisions (n=163 80.7%). Average confidence was rated 4.54 ± 0.67. Results indicate a significant increase in confidence from 2017 to 2020 that patient care decisions are independent of influence. The majority of supervising athletic trainers indicated that they were involved in COVID-19 response (n=190, 94.1%) Conclusions: More NCAA Institutions should transition to a medical model of health care delivery to ensure independent medical care. Athletic trainers were used in the policy creation and implementation of COVID-19 protocols for their institutions and athletics programs.

Physiotherapists’ Perspectives on the use of Telehealth for Service Delivery to Children with Developmental Delays: A Qualitative Focus Group Study

Purpose: The purposes of the study are to (1) determine what barriers and facilitators physiotherapists perceive to using telehealth, (2) to determine willingness to use and (3) to determine perspectives on training in the use of telehealth. Method: This is a qualitative semi structured interview and focus group design. Participants were recruited from the first stage of the larger research process using purposive sampling. A semi structured guide was used to facilitate discussion of shared experiences and to allow themes to emerge from the discussion. Results: Thematic analysis was used to synthesise frequent and important themes. Ten participants took part in either a focus group (n=7) or interview (n=3). Nine main themes identified were split into barriers and facilitators. Facilitators were the right family, right child, adequate technology and space, and collaboration. Barriers were technology, time management, lack of physical touch, lack of organisational support, and work environment. Conclusion: Results suggest that physiotherapists working with children with developmental delay consider telehealth to be unsuitable to replace face-to-face therapy entirely but are willing to use it to provide follow up services to the right family and the right child. Physiotherapists in the study were positive about telehealth’s potential to improve services to children in rural areas. Physiotherapists said that specific physiotherapy training in telehealth was currently lacking.

Assessing Burnout and Resiliency in Online Degree Advancement Respiratory Care Students During a Pandemic

Purpose: The purpose of this study was to identify and quantify the presence of burnout in online degree advancement Respiratory Care students during a pandemic and characteristics/strategies of resiliency. Method: The design of the study was quantitative; non-experimental, descriptive, cross-sectional survey research. The Maslach Burnout Inventory for Medical Personnel (MBI-HSS (MP) and Brief Resilience Scale (BRS) were used to measure these constructs. Results: One hundred and twenty-nine (129) students completed components of the survey for a response rate of approximately 28%. Relevant findings include a somewhat higher level of depersonalization for those who practice in adult acute care. Emotional exhaustion was higher in those who reported working directly with COVID-19 patients. Depersonalization was higher in the younger aged professionals (18-40 years). Resilience was found to have a negative correlation with both emotional exhaustion and depersonalization and a positive correlation with personal accomplishment. Conclusions: Findings support the need for training and education on emotional intelligence and opportunities to practice mindfulness-based stress reduction. Additionally, workload reductions and adequate time for recovery may help alleviate the emotional exhaustion of working respiratory therapists who are pursuing an advanced degree online.

Allied Health Student Engagement in Telehealth Clinical Placements: A Rapid Review

Purpose: The engagement of allied health students in telehealth consultations whilst on clinical placement has rapidly increased due to the disruption caused by COVID-19. While this is understandable given the circumstances, it has occurred on the largely unfounded assumption that utilising telehealth is pedagogically appropriate to supplement or replace assessed placements. Method: This rapid review used the Cochrane rapid review methodology to synthesise the literature relating to the perspectives of allied health students whilst on clinical placements utilising telehealth. Results: A systematic search and selection process found three studies. In summary, the combined findings of the research suggest that student perspectives were generally positive, and several important benefits were reported, including being able to improve knowledge and skills, and reduce anxiety for some consultations. However, students acknowledged that some consultations were considerably more difficult to undertake without being in the same physical space as clients. Conclusions: The methodological quality of these three papers was inconsistent, and collectively the area clearly needs more evidence to support the transition of face-to-face to telehealth environments. Recommendations: Based on broader telehealth literature, the authors propose several recommendations to meet the immediate challenge of insufficient guiding research evidence. These include deconstructing telehealth placements into discrete clinical placement elements, using education theory to support student clinicians to implement a proactive, integrated approach to adopting telehealth as a standard service modality, and investing in and developing infrastructure, policy, systems, education, and training in an explicit, systematic manner. The use of telehealth within allied health clinical placements is here to stay, but considerable work is needed to prepare students for this environment as well as triaging and progressively scaffolding their experiences.

A Pilot Interdisciplinary Falls Screening and Educational Event: Perceptions of Community-Dwelling Older Adults

Introduction: Falls are the leading cause of death and disability among people 65 years of age and older. Likewise, falls have psychological consequences which often lead to avoidance of activities, fear of falling, and further disabilities. Even though the impact of falls on one’s daily life and independence are substantial, evidence suggests that falls can be prevented by multi-factorial assessments and client-specific interventions. Objective: The purpose of this study was to determine (a) perceived knowledge of falls, (b) reported confidence in fall prevention, (c) perceived likelihood of implementing falls screening recommendations, (d) reported fear of falling, and (e) perceived value and satisfaction among community-dwelling older adults who attended an interdisciplinary falls screening and education event. Methods: An interdisciplinary group of professionals from behavioral sciences, family medicine, occupational therapy, optometry, pharmacy, and physical therapy screened 33 community dwelling older adult participants (66-84 years of age) using multi-factorial assessments and discipline-specific screening tools. Individualized recommendations were provided to each participant in verbal and written formats. Participants then completed a questionnaire at the conclusion of the event regarding their perceptions of knowledge gained about falls, confidence in preventing falls, perceived likelihood of implementing fall screening recommendations, fear of falling, and overall feedback regarding the event. Results: The majority of the participants indicated increased perceived knowledge of falls, confidence in preventing falls, and perceived high likelihood of implementing recommendations, along with decreased fear of falling. The majority of the participants also found the event to be valuable (85%), enjoyable (94%), and easy to understand (100%). Conclusion: The results of this study suggest that participants found this falls screening event to be valuable and improved their knowledge regarding falls, as well as their confidence in being able to prevent falls. This study highlights the potential value of an interdisciplinary team approach to increase knowledge, enhance prevention, and decrease fear of falling in community dwelling older adults.

Admission Variables Predict Success in a Hybrid-online Physical Therapist Education Program

Purpose: Screening student applicants can be a valuable measure for hybrid-online Doctor of Physical Therapy (DPT) programs.Institutions embrace a wide variety of measurements that drive admissions decisions. However, uncertainties exist regarding the most accurate admission predictors of academic outcomes, especially among hybrid-online DPT programs. The purpose of this study was to examine predictive relationships between applicants’ admission variables and program grade point average and National Physical Therapy Examination (NPTE) performance in a cohort of entry-level hybrid-online DPT students. Methods: A retrospective cohort design and convenience sampling method was used across two entry-level hybrid-online DPT programs in the Southeastern US. Hybrid-online DPT programs utilized ≥51% online instructional delivery. Applicants’ undergraduate admissions records, DPT program academic records, and NPTE scores were collected. Multiple linear regression analyses tested the hypotheses. Cross-tabulations and McNemar’s test were used to identify cut-off scores for variables and odds-ratios of passing the NPTE. Results: N=377 were collected and analyzed from two hybrid-online DPT programs (N=143 [38%] Program A; N=234 [62%] Program B) between Fall of 2018 and Spring of 2020. Applicant undergraduate (uGPA) and trending (tGPA)(final 60 credits) predicted first-time NPTE pass rate (r2 = 0.30, p2 = 0.18, p2 = 0.26, p = 0.02), F(6, 370). Applicant uGPA and tGPA were associated with 3-fold and 2-fold increase odds of passing NPTE on the first attempt, respectively. Conclusions: This study suggests certain applicant variables may be more indicative of success and could be weighted more heavily during the application process. Cumulative and trending undergraduate GPA accurately predict academic performance in hybrid-online DPT education, and NPTE scores. Notably, GRE and undergraduate science GPA were unremarkable. Hybrid-online DPT program GPA strongly predicts outcomes in NPTE scores.

Relationship Between Estimated VO2max and Handgrip Strength in Healthy Young Nigerian Adults

Purpose: This study investigated the relationship between estimated oxygen consumption (VO2max) and handgrip strength (HGS) among healthy young Nigerian adults. Methods: This was a cross sectional study, which involved 400 volunteers (171 males; 229 females) aged between 18–40years. Participants’ HGS was assessed using a CAMRY EH-101 hand dynamometer while VO2max was estimated using a standard formula that includes measurement of resting heart rate. Demographic data was summarized using percentages, mean and standard deviation. Physical activity level of the participants was assessed using long form of the International Physical Activity Questionnaire. Independent t-test was used to compare the mean values of the variables between male and female participants. Pearson’s correlation was used to determine the strength of relationship between estimated VO2max and HGS, while multiple regression analysis was conducted to determine the predictors of estimated VO2max using HGS as well as body mass index (BMI), physical activity (PA) level, age and sex as co‐variates. Level of significance was set at p<0.05. Results: HGS, VO2max and PA level were significantly (p= 0.001) different between male and female participants. There was a significant moderate correlation between HGS and VO2max (r= 0.40, p= 0.001). The results of the regression analysis showed that HGS is not significant predictor of estimated VO2max; whereas, sex, BMI and PA level were significant predictors of estimated VO2max. Conclusion: Although HGS is moderately correlated with estimated VO2max, HGS may not be a relevant tool for predicting estimated VO2max in healthy young adults.

Adaptive Staffing Models and their Translation to Future Disaster Response: What Can Be Learned from COVID Unit Staffing?

Background: As much as hospital organizations like to be prepared for worst-case scenarios, situations inevitably arise that are unanticipated for which no amount of preparation would ever suffice. One such scenario was the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19). Hospitals had to use their existing staff in order to meet the onslaught of patients presenting with COVID-19. Purpose: The aim of this paper is to review the various COVID unit hospital staffing models that were implemented during the influx of patients with COVID-19 and then to examine their sustainability and adaptability to response models for future disasters. Hospitals are equipped with rapid response teams and some with disaster response teams, but neither is designed to be on a massive scale or for an extended duration. Which teams worked well, and can any be used in future disaster response staffing models? Conclusions: An adaptive and sustainable disaster response team is more about the members who make up the team, than it is about the response. The training and knowledge of health care providers determines staffing model adaptability and these characteristics can be targeted when making decisions on hiring, training, ongoing education, and staff assignments.

The Effect of Instructor-to-Student Ratios, Academic Preparation, and Selective Admissions on Retention Rates Among CAAHEP Accredited Paramedic Training Programs.

Purpose: This study was a non-experimental evaluative study designed to identify the effects of instructor-to-student ratios, academic preparation, and selective admissions processes on retention rates among CAAHEP accredited paramedic training programs in the United States. Methods: Self-reported data from accredited program directors was analyzed to identify what relationships, if any, existed among the variables. Results: Results showed no effect of instructor-to-student ratios or academic preparation on retention rates. However, those programs that utilized selective admissions processes reported a statistically significantly higher student retention rate when compared to those that did not. Conclusions: Paramedic programs seeking to improve retention rates should consider utilizing a selective admissions process.

Attitudes and Beliefs of Physical Therapist and Physical Therapist Assistant Program Directors in the United States Towards Interprofessional Education

Purpose: To investigate the attitudes and beliefs of physical therapy (PT) and physical therapist assistant (PTA) program directors towards interprofessional education (IPE). We hypothesized that Communication and Ethics would be the most important competencies among program directors. Methods: A cross-sectional survey based on previously utilized instruments modified for the profession of PT was sent to PT and PTA program directors. One hundred sixteen responses were analyzed using frequency analysis for demographic data and non-parametric Mann-Whitney U t-test for group differences. Results: While the majority of program directors agree that IPE is important, with Communication as the most important IPE competency, most PTA program directors do not support the importance of accreditation in implementing IPE (pConclusion:Program directors agree that IPE is vital to student learning, with Communication as the most important IPE competency. However, specific differences between PT and PTA program directors emerged primarily on IPE implementation, the role of accreditation, resource support, and resource utilization.

Clinical Supervision in Singapore: Allied Health Professional Perspectives from a two-round Delphi Study

Purpose: This study investigated Allied Health Practitioners’ (AHPs) perspectives on and consensus of clinical supervision in an acute tertiary hospital in Singapore. Specifically, AHPs’ views on the benefits of and barriers surrounding engaging in clinical supervision, as well as strategies for enhancing clinical supervision experience. Method: A Delphi approach utilizing a two-round process via online questionnaires was employed. A total of 77 AHPs responded to the first round of the Delphi questionnaire and 55 AHPs completed the second round (71% retention rate). Open-ended responses from the first round underwent thematic analysis and resulted in sixty statements (five themes) describing engagement in clinical supervision. In the second round, AHPs were asked to rate each characteristic of clinical supervision on a 5 point Likert Scale. Results: Consensus was reached on 52 statements using a cut off of greater than 68% positive respondents and an interquartile deviation (IQD) ≤1. The study identified 52 statements considered important for successful clinical supervision for AHP in an acute tertiary hospital in Singapore. Conclusions: The themes and underpinning statements provide insights about clinical supervision in the Singapore hospital setting.

Impact of Clinical and Cultural Activities on Personal Growth During International Service-Learning

Purpose: When healthcare students participate in international service-learning experiences, they are exposed to a culture that is different from their own. This exposure, accomplished through cultural and clinical activities, can help to develop their clinical skills and result in personal growth. However, the individual impact of clinical versus cultural activities on personal growth is poorly understood. This study examines the impact on personal growth of clinical activities and cultural activities during international service-learning in occupational therapy students. Methods: Qualitative interviews using a phenomenological approach were utilized to explore the lived experiences of American occupational therapy students who traveled to Morocco. Responses were coded and analyzed to identify general themes on the impact of different clinical and cultural activities. Qualities of impactful experiences were also identified. Results: Participants identified authentic clinical activities that elicited an emotional response and cultural activities that involved full cultural immersion as being most impactful for their personal growth. Conclusion/Recommendations: To support healthcare students’ personal growth, international service-learning should be designed to include authentic clinical activities that elicit emotion and reflection and opportunities for full immersion into the culture of the country abroad.

Language Discordance and Telephone Interpretation Complicates Pain Neuroscience Education in Physical Therapy Management of a Patient with Acute Low Back Pain

Purpose: Pain neuroscience education (PNE) is an intervention used for musculoskeletal pain to improve understanding of pain processes; PNE can decrease pain levels, improve function, and lower disability. Clear communication between the patient and provider is important for PNE to be an effective intervention. There is a lack of research on how a language discordance may impact that communication, and therefore the effectiveness of PNE. Purposes: 1) describe the physical therapist management of a Spanish speaking patient with acute low back pain (LBP) while using an off-site telephone interpreting service and 2) examine how PNE treatment was impacted by a language discordance. Methods: A female in her early 40’s presented with LBP two months after a motor vehicle accident. A systems review revealed comorbidities of class 1 obesity and prediabetes and a language discordance between the provider and patient, necessitating the use of a telephone interpreter. While acute LBP is usually self-limiting, the language discordance and comorbidities were expected to negatively impact her functional prognosis. Intervention included PNE, strengthening, directional preference exercises, graded exposure, and body mechanics training. Results: Within 5 weeks, the patient’s self-perceived disability as reported by the Spanish translated and culturally adapted Oswestry Disability Index, thoracolumbo-pelvic hip range of motion, and perceived levels of pain improved significantly. Conclusion: The link between clarity of communication while utilizing PNE and patient comprehension, outcomes, and satisfaction is unclear. While more time consuming, PNE delivered via translations services appears to be an effective physical therapy intervention. However, further research is needed and it is important for physical therapy providers to consider how language discordance could impact the effectiveness of PNE.

Pivoting to be Patient-Centered: A Study on Hidden Psychological Costs of Tele-Healthcare and the Patient-Provider Relationship

Purpose: While the COVID-19 pandemic has necessitated a shift toward virtual medicine, there are some potentially important limitations with this modality of healthcare. One such concern, which has not yet been elucidated, is how telephone-based versus in-person visits differentially impact patients’ perceived autonomy and the resulting patient-provider relationship. Grounded in self-determination theory (SDT), this pilot study addresses this question by investigating the association between patients’ perceived autonomy support and relationship needs satisfaction (autonomy, competence, relatedness) in both types of visits with their family doctor and care team. Methods: Running from Sept. 2020 to Feb. 2021, data was collected via convenience sampling from n = 66 patients (34 in person, 32 virtual) nested within k = 6 family physicians. Patients completed an online survey containing two previously validated scales derived from SDT: The Healthcare Climate Questionnaire and the Basic Need Satisfaction in Relationships Scale. Each scale was adapted to reflect a virtual or in-person visit experience. A random effects model captured the relationship between the motivational variables in each group, adjusting for various sociodemographic effects. Results: Both groups’ perceived autonomy support positively related to their relationship needs satisfaction with their family doctor and care team. Compared to traditional in-person visits, patients perceived the virtual healthcare climate as significantly less autonomy-supportive. Conclusions: In line with SDT, findings from this study suggest that when patients sense a more autonomy-supportive healthcare climate, they will experience a more needs-satisfying relationship with their family doctor and healthcare team. These results have potentially significant implications for supporting patient motivation and facilitating optimal health and wellness outcomes, particularly within the virtual care environment.

An Appreciative Inquiry Approach to Understanding What Attracts and Retains Early-Career Therapists to Work in Community Organizations

Purpose: Community health organizations are expanding in many countries to meet the health and care needs associated with an aging population, an increase in recognition of children with developmental and mental health needs, and escalating healthcare costs. Singapore is no exception. Community organizations, however, are facing challenges in recruiting and retaining early-career therapists to these positions due to competition from acute services and a declining foreign talent pool. At the same time, early-career therapists encounter challenges during the transition from student to professional. Community organizations, therefore, need to identify what makes their organization attractive to early-career therapists and what makes them stay. This study explored factors that attracted and retained early-career therapists in community organizations in Singapore from the perspectives of early-career therapists and supervisors. Methods: Appreciative Inquiry was adopted as a strengths-based approach to guide this qualitative study process. Focus groups were conducted with three groups of early-career therapists and supervisors, to explore perspectives of what attracted them to work in a community health organization and what factors retained them in their roles. Two phases of focus groups were held three-weeks apart, giving early-career therapists and supervisors the opportunity to consolidate and expand their ideas. Focus groups were audio-recorded, transcribed, and thematically analyzed. Results: This study highlighted three key factors which attracted and retained early-career therapists to the Singapore community health organizations: (1) a culture that values learning and professional development; (2) structured supervision that is timely and individualized; and (3) a system that supports job satisfaction and promotes staff wellbeing. Conclusions: This study highlighted that community organizations could enhance their attraction and retention of early-career therapists through a focus on opportunities for early-career therapists’ formal and informal learning and professional development opportunities. Having a clear supervision framework and continuing development for supervisors is another key attraction for early-career therapists. Finally, time and opportunities to develop meaningful relationships with colleagues and clients enhances job satisfaction and wellbeing of early-career therapists. Making explicit the offer in these three areas could enhance applications and the retention of early-career therapists to these services.

Action Observation Training Reduces Freezing of Gait Among Individuals with Parkinson’s Disease: A Systematic Review

Purpose: Recent evidence suggested action observation training (AOT) may benefit individuals with Parkinson’s disease (PD) experiencing freezing of gait (FoG). The purpose of this study was to determine if AOT can effectively decrease FoG among people with PD. Method: This review followed PRISMA guidelines and was registered a priori with PROSPERO. The databases PubMed, CINAHL, Cochrane Database of Systematic Reviews, PEDro and PROSPERO were searched. Inclusion criteria were randomized controlled studies, an intervention with AOT, adult subjects with PD, published in a journal, and written in English. Study quality was evaluated with the APTA Critical Appraisal Tool for Experimental Intervention Studies (CAT-EI), and level of the evidence with the Oxford Centre for Evidence-based Medicine – Levels of Evidence for Therapy/Prevention Studies Rating Scale. Results: Five studies met inclusion criteria and yielded 145 participants with a mean age of 69.5 years. Most evidence was rated as acceptable quality, one study rated as low quality, and the level of evidence was high. The studies had participants undergo approximately one hour of intervention, typically two or three times a week for a period of four to eight weeks. Intervention with AOT resulted in significant improvements for the outcome measures of the Timed Up and Go Test (TUG), 10 Meter Walk Test (10MWT), self-reported FoG Questionnaire, self-reported New FoG Questionnaire, and FoG score on the Unified PD Rating Scale. Conclusions: Based on an acceptable level of evidence, there was a significant effect from the intervention of AOT for decreasing FoG among people with PD. Recommendation is that AOT effectively reduces FoG among people with PD and is a feasible and safe intervention.

Transformation of the Physical Therapist Assistant (PTA): A Survey of Current Practice and Education

Purpose: To find trends in utilization and practice of the physical therapist assistant (PTA) in the clinical setting and to assess current clinician views on the expected future direction for the education of the PTA. Method/Subjects: An electronic survey was sent to all accredited PT and PTA programs in United States requesting the survey be forwarded to physical therapist and physical therapist assistant faculty, alumni and clinical instructors in their geographic region for completion. Results: PTAs are a vital part of physical therapy practice. Forty percent of respondents reported that greater than 50% of direct patient interventions are typically delegated to a PTA. Most common interventions not performed by the PTA but is considered a delegable activity include manual techniques and manual muscle testing. Survey results indicated current challenges faced in delivery of healthcare services related to the role of the PTA to be: lack of PTA career development opportunities (n=615), underutilization of the PTA skills/ services (n=585) and productivity standards (n=545). Physical therapist respondents (72.5%) reported they completed informal skill training or mentoring with the PTA in the clinic to allow for tasks to be delegated to the PTA. There was consensus among both PT (52.5%, n=399) and PTA’s (53.8%, n=472) that a transition that included a baccalaureate degree was the appropriate career path for the PTA. Conclusions: When coupled with the Federation of State Boards of Physical Therapy (FSBPT) reports of entry level practice expectations, this report could prove valuable in future decision-making regarding PTA degree expectations as well as educational requirements and training to meet the needs of those seeking physical therapy services within our current and future healthcare system.

Female Mentors and Gender Dynamics in Athletic Training

Purpose: Female athletic trainers face barriers in accessing female mentors due to the small numbers of same-gender leaders in athletic training. The purpose of this study is to explore the experiences of clinically practicing female athletic trainers with mentorship. Method: Twenty-three (23) athletic trainers who identified as female and had at least 3 years of clinical experience. Interviews occurred using a semi-structured interview script. All teleconference interviews were audio-recorded and transcribed verbatim. A 3-person research team analyzed the data and coded it into domains and categories based on the consensual qualitative research process. Credibility was established with multiple researchers, an external auditor, and member checks. Results: Three domains emerged from the data: (1) foundations of mentor relationships, (2) the benefit of mentor relationships, and (3) the influence of female mentors. Participants identified mentor behaviors they value such as not judging, communicating openly and regularly, guiding, challenging, trusting, and supporting. Participants indicated they benefited from their mentor relationships with an evolving friendship, career advancement, administrative support, relationships management, confidence, and empowerment. Participants identified unique influences of female mentors, specifically helping them manage gender-specific challenges and modeling work-life integration. Participants stated an obvious lack of female mentors in athletic training. Conclusions: Findings suggest those that are identified as mentors, regardless of gender, demonstrate foundational behaviors that yield benefits to their mentees. However, the findings also suggest a significant absence of female mentors in athletic training. With the limited number of females in leadership or mentor roles in the field, it is difficult for females to access same-gender mentorship. With this lack of same-gender mentorship, female athletic trainers may face more significant obstacles in managing gender-specific dynamics and challenges in clinical practice.

Feasibility and Acceptability of a Pilot Knowledge Translation Telementoring Program for Allied Health Professionals

Purpose: Knowledge translation (KT) in the health system is critical for the delivery of evidence-based practice. Supporting allied health professionals to plan and implement KT, using strategies that broadly reach across multiple geographical locations of the workforce, are needed. We piloted KT group telementoring via videoconference as an innovative solution to support and empower a vastly dispersed workforce.

Methods: The 6-month Knowledge Translation Support Service (KTSS) involved monthly, one-hour, virtual group-based support of clinician-led KT projects within state-run hospital and health services. Supported by an independent facilitator, a panel of KT experts and health service leaders provided constructive critique and KT support for four projects from various disciplines (dietetics, nursing, occupational therapy, physiotherapy and social work) and health districts. Process evaluation included an assessment of program fidelity, dose delivered and engagement. Program acceptability (participants and panel members) was assessed after each session through online surveys. Effectiveness was captured by survey of KT confidence and qualitative interviews of participants perceived benefits of participation.

Results: All project leads attended each meeting, with 1-2 specific projects discussed each month. On completion, participants reported high program satisfaction and felt that the KTSS met their expectations and learning needs. Overall the participants described beneficial gains with confidence in KT skills.

Conclusions: The telementoring offered exposure to a breadth of expertise not normally accessible, successfully built a team environment in the virtual space and had a positive impact on project progression. Future directions include investing in scalability and sustainability of telementoring strategies for KT support.

Collegiate Athletic Trainers’ Experiences Planning for Return-to-Sports During COVID-19: A Qualitative Research Study

Purpose: The purpose of this study was to explore the role of intercollegiate head athletic trainers in the process of planning to resume sport, as well as their experiences across the course of the pandemic to identify key strategies, challenges, and future considerations during the Covid-19 pandemic. Method: This exploratory, descriptive qualitative study was conducted via one-on-one semi structured interviews through the Zoom video conference technology. Twenty-four head athletic trainers across NCAA Division I, II, and III institutions participated in the study. Results: Emerging themes included the development of detailed, institution-specific plans with shared elements such as policies for testing and screening, modifications to facilities and cleaning, and incorporation of coach and athlete education. Athletic trainers discussed the processes they used to create their return-to-sport policies, which included professional development and interprofessional collaborations. While participants were confident in their plans, they acknowledged the need to overcome logistical and psychosocial challenges, such as the recognition that the success of their plans relied on numerous variables that could not be completely controlled. Conclusion: It is clear that NCAA ATs have played – and will continue to play – an integral role in overcoming challenges to promote a safe return-to-sports amidst the COVID-19 pandemic via education, policy making, and delivery of healthcare services. The challenges imposed by the accompanying set of circumstances have strained these ATs’ practical tendencies and procedures. ATs have met these challenges through collaboration, information-seeking, and acceptance of the situation. NCAA ATs have embraced the opportunity to lead the way towards safe, successful campus reopening and resumption of competition.

Impact of Pro Bono Clinic on Attitudes, Beliefs, and Confidence Towards Cultural Competence in First-year Doctoral Physical Therapy Students

Purpose: Cultural competence is an essential skill for healthcare providers in our increasingly ethnically diversified society. There is an unmet need for educating future culturally competent physical therapists. The purpose of this study was to investigate the impact of pro bono clinic on cultural competence in first-year doctoral physical therapy students. Method: Forty-two participants completed a survey before and after attending three individual sessions of mentored pro bono clinical experiences during their first semester. The survey assessed participants’ attitudes and beliefs (Part I), and self-perceived level of confidence (Part II) towards cultural competence. Wilcoxon signed-rank tests were performed. Results: The mean scores increased from pretest (4.13 ± 0.55) to posttest (4.22 ± 0.48) for Part I (5: highest scale) and from 7.34 ± 0.96 to 8.01 ± 0.79 for Part II (10: highest level) but were not significant. Overall findings showed a positive impact which was reflected by students’ narrative comments post-participation (Part III). Conclusion: This study is novel due to limited evidence in this area, especially the effect of an early intervention. Pro bono clinic participation may be an effective approach that could be incorporated early in curriculum across allied health science education.

A Student Physical Therapist’s Perspective on her Efficacy Providing Culturally Competent Care: A Reflective Case Study

Purpose: Cultural differences and personal biases can affect the way a clinician provides care and the way in which patients receive it. The Commission on Accreditation in Physical Therapy Education (CAPTE) designates cultural competence as one of the professional practice expectations for physical therapy students, although no standardized blueprint exists for Doctor of Physical Therapy (DPT) programs. This case report will illustrate how reflection can be used to facilitate a student’s growth into becoming more prepared to practice in a culturally aware and effective way. In addition, this report seeks to provide a student’s perspective on her efficacy providing culturally competent care, given her training and education through her DPT program. Method: This case report will present the interactions between a student physical therapist (SPT) and a culturally and linguistically diverse patient throughout a physical therapy plan of care. Subsequently, the reflections by the SPT on these interactions will be presented, and themes such as communication barriers, power dynamics, and patient expectations will be explored. Results: Through the student’s self-reflection, she determined both her strengths and areas needing improvement in providing an adequate cross-cultural interaction, in addition to delineating how her preparation in school affected these areas. Her strengths included 1) vulnerability to recognize her own shortcomings, and 2) a desire to create a meaningful connection with the patient. The areas needing improvement included 1) providing an open space for the patient to speak, and 2) setting patient expectations. The student’s DPT program facilitated her preparedness in cultural competence by 1) providing lecture content promoting cultural awareness, 2) encouraging reflection, and 3) hosting an event where the DPT students were able to work with international students of limited-English proficiency. Conversely, barriers to the student’s preparedness included 1) no mandatory community service reaching minority populations, and 2) no opportunity for an abroad immersion experience. Conclusions: Two main themes were drawn from the student’s reflection. First, continual self-evaluation and vulnerability are imperative to the process of becoming a culturally competent provider. Second, clinical experience dedicated to providing care to minority populations appears to be effective in fostering cultural competency in DPT students.

The Impact of #365Papers: A Daily Scientific Twitter Campaign to Disseminate Exercise Oncology Literature

Purpose: Many health researchers and practitioners use Twitter to stimulate scientific dialogue and collaboration among peers, as well as the general public. In 2018, the Clinical Exercise Physiology Lab (CEPL) undertook a year-long scientific Twitter campaign (#365Papers) where one peer-reviewed publication related to cancer and exercise/physical activity was tweeted per day. Features of this campaign included Throwback Thursdays (selected article published before 2018) and guest tweeters (article chosen by other exercise oncology researchers). We report on the impact of the #365Papers campaign based on Twitter Analytics data (i.e., engagement rate). We also explore how engagement rate differed depending on publication features (e.g., type of research, journal impact factor, Altmetric Attention Score) and campaign features (i.e., Throwback Thursdays, guest tweeters). Methods: Campaign data were obtained from Twitter Analytics (Twitter, 2020: San Francisco, USA). Publication information (i.e., type of research, journal) was extracted by screening titles and abstracts, while each publication’s Altmetric Attention Score was obtained using the Altmetric Bookmarklet (Digital Science, Holtzbrinck Publishing Group, 2020: Stuttgart, Germany). Twitter Analytics data were summarized using descriptive statistics. Differences in engagement rate were analyzed based on research type (e.g., randomized controlled trial), journal impact factor, Altmetric Attention Score, and if the publication was posted as part of a Throwback Thursday or by a guest tweeter. Results: The #365Papers Twitter campaign received a total of 688,117 impressions and 22,124 engagements, with a median engagement rate of 3.2% and the majority of engagement from URL clicks (n=8279; 37%). The mean monthly increase in CEPL Twitter account followers was 48 (±18). Engagement rate did not differ based on type of research (p=0.53), journal impact factor (r=-0.06; p=0.27), Altmetric Attention Score (r=0.01; p=0.80), nor if the tweet was part of a Throwback Thursday (p=0.97). However, guest tweets had significantly higher engagement rates versus non-guest tweets (median: 3.6% vs. 3.1%; p=0.01). Conclusion: Our findings suggest the potential of a daily scientific Twitter campaign to stimulate peer and public engagement and dialogue around new scientific publications, especially when prominent figures in the research field are incorporated into the campaign process.

Implementing Strategies for Strengthening Australia’s Rural Allied Health Workforce

Purpose: In many rural places, health services struggle to maintain an adequate health workforce to meet their communities’ health care needs. Shortages of allied health professionals are of particular and growing concern. To address this challenge, a two-year Whole-of-Person Retention Improvement Project was developed involving a research partnership with two rural public health services in Victoria, Australia. This project was informed by the author’s Whole-of-Person Retention Improvement Framework (WoP-RIF), aimed to produce new knowledge for rural health services to attract, recruit, and improve the retention of allied health professionals. A set of evidence-informed and contextually relevant recommendations were made in the project’s initial observational phase to strengthen each service’s allied health workforce, 10 of which were shared. The objective of this phase of the project was to explore the challenges and enablers that two rural health services experienced in developing and implementing strategies for allied health workforce improvement. Method: The methodological approaches used for this intervention study were participatory action research and a realist evaluation. The data sources used for the realist evaluation included qualitative (focus group) and observational (project documents and fieldnotes). Results: The results outline the key responses made by the regional and rural health service to implement the 10 shared recommendations and are presented under their relevant WoP-RIF domains: workplace/organisational, role/career, and community/place. The key and shared contexts, drivers, mechanisms, outputs, and outcomes are presented under each recommendation, and where possible, an assessment is made regarding sustainability beyond the project period. Conclusions: The implementation of the recommendations is a complex process requiring whole-of-organisation support by the participating rural public health services. This study identifies five facilitators for successful implementation: 1) the project is considered a strategic human resources initiative and overseen by the executive; 2) it has strong champion(s) in the executive staff; 3) human resources is part of the strategic decision-making arrangements; 4) the change management process is facilitated and led by staff from the target clinical workforce(s); and 5) a partnership approach with local council is adopted for strategies requiring community support and engagement.

Clinician Productivity During Student Full Time Clinical Experiences

Purpose: Clinical education is an essential part of physical therapy education. Clinicians who provide student clinical training have the primary responsibility of patient care and meeting their job demands including meeting productivity standards. Adding a student to the mix is often perceived as negatively impacting productivity. The purpose of this study is to examine the impact on clinician productivity in direct patient care while hosting a student for a clinical experience. This study (a) investigates differences seen when hosting a DPT student or a PTA student; (b) compares differences seen influenced by which curricular stage the student is in for the clinical experience; and (c) investigates the impact on productivity while hosting a student across various clinic settings. Method: Clinical instructors for DPT and PTA students from three academic institutions were asked to participate while hosting one of the institution’s students. Information was taken on daily hours worked, number of patients seen, and units billed for the week before the student arrived and during the student’s full-time clinical experience. Data collected was analyzed for changes over time and for comparison of baseline data to collective (net) averages for all weeks in which the student was present. Sub-analysis was done on curricular timing of the rotations (initial, intermediate, or final), types of settings (inpatient, outpatient or other), and types of students. Results: While there were several significant changes over time in the components assessed, there were no significant differences when comparing baseline productivity components to the collective weekly averages. Conclusion: It appears that hosting students during full-time clinical experiences does not affect the overall productivity. There is generally the predictable drop initially that recovers to baseline around week 4 while either maintaining or increasing productivity during the remaining weeks to produce a net neutral or positive impact. This study works to ultimately disprove the common belief that clinician productivity is negatively impacted while hosting a student during a clinical experience.

Kinematic Analysis of a Series of Jumps In First Position In Professional Ballet Dancers

Purpose: Few ballet-specific studies in the literature examine kinematics during dance activities. Sports studies have identified injury risk in athletes by observing kinematics during specific activity, but this has not yet been explored for ballet. Evaluating kinematics in dancers has the potential to identify injury risk and influence treatment for prevention and rehabilitation. Therefore, the purpose of this study was to examine the landing kinematics of professional ballet dancers during a series of 16 ballet-specific jumps. Methods: This study was a multi-factor repeated measures design. Participants (3 males, 16 females aged 19-33 years; first or second company members) performed 16 consecutive sautés in first position to a metronome set at 120 beats per minute. Lower extremity kinematic data was captured using the Noraxon myoMOTIONTM system and was analyzed at peak knee flexion of landing on jumps 1, 8, and 15 for hip abduction (HA), hip flexion (HF), and hip external rotation (HER). Analyses included: right versus left side differences (RvL), differences between jumps 1, 8, and 15, and interaction between the specific jump and RvL. Results: Statistically significant differences (SD) were found in: RvL HA (p=0.000, 10.68 degrees; clinically relevant) and in HF between jumps 1 and 8 (p=0.000) and 1 and 15 (p=0.006). There was no interaction effect of HA between jump number and RvL (p=0.470) or of HER between jump number and RvL (p=0.599). There was no SD in: HF between jumps 8 and 15 (p=0.245), HA between jumps (p=0.062), RvL HF (p=0.190), RvL HF between jumps (p=0.972), HER between jumps (p=0.366), or RvL HER (p=0.562). Conclusions: The RvL difference in HA (p=0.000) suggests asymmetrical loading of hip joints. This difference did not change between jumps (p=0.062), suggesting repeated preferential frontal plane loading. The SD in HF between jumps 1 and 8 (p=0.000) and 1 and 15 (p=0.006) suggests that a small series of jumps that are standard in ballet class are not consistent motions for professional dancers. Limitations include small sample size and lack of controlled warm up. Future work should examine single leg jumps or sautés following a fatigue protocol to assess joint motion more accurately.

Intensive Robot-Assisted Gait Training in Individuals with Chronic Spinal Cord Injury: Case Series from Saudi Arabia

Purpose: The aim of this study was to report whether intensive body weight-supported treadmill training with a robotic exoskeleton could improve over-ground functional mobility in individuals with chronic spinal cord injury and to investigate its feasibility and safety. Methods: This was a case series design. Two male individuals with chronic (> 1 year since injury) spinal cord injury (SCI) were included in this study. All subjects underwent intensive gait training sessions 5 times per week using exoskeleton for 12 weeks with a total of 60 sessions. The duration of the session was 60 minutes, including the installment of the HAL, gait training, and the removal of the HAL. The training was performed on a treadmill with adjustable speed and a lifter, under the supervision of a physiotherapist. Two types of outcomes were collected: treadmill-associated data and functional outcomes. Results: We observed a continuous increase in treadmill walking distance, time, and speed for both cases from baseline assessment until the end of the study at 12 weeks The findings from this study provide evidence that the Hybrid Assistive Limb (HAL) can be used with chronic spinal cord injury and can improve walking abilities in terms of distance, speed, and time. Conclusion: HAL can be used for gait training in rehabilitation facilities for individuals with chronic spinal cord injury and did not cause any serious adverse effects to the participating subjects. Our results support the findings of previous studies that show that treatment with HAL may result in improvement in gait parameters. However, more studies with a larger sample size are needed to compare the effect of HAL with conventional physical therapy

Short-term Service-Learning: Implications for Preparing Health Science Students for Practice

Purpose: The purpose of this paper is to examine students’ self-reported learning outcomes following participation in collaborative interprofessional service-learning experiences through the qualitative analysis of participants’ written, guided critical reflections. Method: Participants responded to guided reflection questions pre and post trip. The four pre-trip open-ended reflection questions included: what the students expected or hoped to learn, how they expected to learn this, the importance of this learning for their career skill development and how this learning could be used in the future. Upon completion of the service-learning experience, students were asked the same questions with slight variation- What did they learn, how did they learn this, the importance of this learning for career skill development and how this learning could be used in their future practice. Open coding strategies were employed to guide the researchers’ analysis of the student participants’ written responses. Results: There were 145 participants in the study, including 86 students in a comparison group and 59 students who participated in service-learning trips during 2018 and 2019. Service-learning participants majored in nursing (47.4%, n=28) and occupational therapy (33.9%, n=20), with fewer participants in pharmacy (n=5), physical therapy (n=5) and social work (n=2). Comparing pre and post service-learning group responses, researchers noted that the post-trip reflections included more depth, breadth and insight compared to the pretest reflection responses for each theme. Post trip responses also included the additional theme of personal growth. Post-trip participants reported having a greater self-awareness of their own limitations and strengths, having a broadened perspective, experiencing spiritual growth, and developing attitudes of gratefulness, humility, flexibility, patience, and empathy after participating in the trip, reinforcing the idea that immersion created learning is exponential when it is experiential. Conclusions: Service learning coupled with guided critical reflection is an effective tool in enhancing interprofessional collaboration. Qualitative analysis of students’ self-reported learning through written reflections served as a valuable means for capturing learning outcomes related to interprofessional collaboration competencies.

The Effect of Case Presentation on Student Physical Therapists' Clinical Reasoning Hypotheses

Purpose: Clinical reasoning is an essential skill for Physical Therapists to develop for making sound decisions regarding patient care. Case-method teaching is an instructional strategy commonly implemented in physical therapy professional education programs for facilitating clinical reasoning skill acquisition. One advantage of case-method teaching is the various ways cases can be portrayed. The purpose of this study was to identify how a case is portrayed effects student thinking and their subsequent clinical decision making. Method: Third-year student physical therapists (n = 14) working in dyads clinically reasoned through a hypothetical musculoskeletal case presented via written case study or simulated patient experience. Talk aloud methodology via concurrent reports was implemented for data collection. Mann-Whitney U-tests followed by manual calculations of effect sizes were conducted for comparing hypothesis category generation between groups. Results: A total of 14 hypothesis categories were generated by the student dyads during the problem-solving sessions. Specifically, students generated more ideas regarding health condition, and contextual factors when thinking through a written case study whereas significantly more thoughts regarding symptom characteristics, client perspectives, and minimizing reasoning errors were generated during simulated patient experiences. Conclusion: When implementing case-method teaching, physical therapy academic educators need to be aware that the manner a case is portrayed affects the clinical judgements students generate and their learning of clinical reasoning. Future research should continue to investigate these effects and how they ultimately impact clinical practice.

Physical Examination Findings in Patients with Protracted Concussion and the Impact of an Integrative Concussion Rehabilitation Protocol

Purpose: To describe physical examination (PE) findings of individuals with protracted concussion recovery and evaluate an integrated primitive reflex (PR) disinhibition, vision, and vestibular rehabilitation intervention. Method: Retrospective study of 82 patients with protracted concussion (60.98% female) who received ≥ 2 phases of treatment. Following a baseline PE, patients completed the Post-Concussion Symptom Survey (PCSS), Activities-Based Balance Confidence Questionnaire (ABC), Dizziness Handicap Index (DHI), and Acquired Traumatic Brain Injury (aTBI) Vision Questionnaire. A subset of patients (Group 1), completed a final PE and second questionnaire administration. Descriptive statistics characterized the sample. T-tests and Wilcoxon rank sum tests compared characteristics of Group 1 vs Group 2. Wilcoxon sign rank tests assessed changes in patient-reported outcomes. Results: Patients in Groups 1 (median age=23.5) and 2 (median age=17.5) were similar regarding demographic and PE findings. Statistically and clinically significant improvements were seen for Group 1: PCSS (-21 points, MCID 6.8), DHI (-27 points, MDC 17.8, MCID 19), ABC (+ 8.5 points, MDC 9)and aTBI Vision Questionnaire (-16.5 points). Conclusion: Patients with protracted concussion recovery can benefit from a multitude of interventions ranging from orthopedic to vision and vestibular interventions in order to address objective deficits and subjective complaints such as headache, dizziness, or blurry vision following a concussion. Patients who completed the full intervention demonstrated clinically significant improvements in function, including return to school/work and recreational activities. These data suggest there is a potential positive benefit to a structured, integrative concussion rehabilitation approach for individuals with protracted concussion recovery.

Career Motivations and Aspirations of Dietetic Students: Applying the Social Cognitive Career Theory

Purpose: The purpose of this study was to describe the career motivations and aspirations of dietetic students using the Social Cognitive Career Theory (SCCT). The objectives were to identify and quantify 1) the factors that motivate current students to choose dietetics as a career, 2) the future career aspirations of dietetic students, and 3) the way in which dietetic students make career decisions. Methods: This descriptive study utilized the validated Career Aspirations and Motivations of Dietetics Students (CAMDS) survey. Program directors of the Accreditation Council for Education in Nutrition and Dietetics (ACEND)-accredited programs shared the CAMDS survey with their students electronically. A resulting convenience sample of n=328 students were enrolled in a didactic program in dietetics, dietetic internship, coordinated program in dietetics, or future education model graduate program. Data was captured regarding demographics, path towards a career in dietetics, motivations and influences to practice as a dietetics professional, and future career aspirations. Descriptive statistics were used to convey study findings. Data were both nominal and ordinal. Results: The majority of participants were female, white, and born after 1980. Motivating factors to pursue dietetics included cooking with family during childhood; a personal interest in nutrition; the influence of a parent or legal guardian; social media; and the opportunity to help others. The preferred employment sectors were clinical dietetics, community dietetics, and private practice. Conclusions: Attention to the career motivations and aspirations of dietetic students is requisite to supporting the growing demand for credentialed dietetics practitioners. The vast majority of current dietetic students are classified as millennials or generation Z; these students have career motivations and aspirations that are distinct from previous generations of dietetic students.

Parental Awareness of Early Intervention for Hispanic Children with Communication Disorders

Purpose: Children at risk of delayed speech and language development and speech-language disorders come from a broad range of demographic backgrounds, including ethnicities, sexes, and socioeconomic statuses. A vast body of research in speech-language pathology has demonstrated that early intervention is crucial for helping children acquire the necessary communication skills they need to become effective communicators, successful students, and ultimately accomplished adults. Currently, commercials, billboards, online sources, and personal referrals are the methods most often used to promote awareness of early childhood intervention services. Method: This study aimed to identify whether the current promotional methods used to increase parental awareness of early childhood speech therapy intervention are effective in the Hispanic population in South Texas. A total of 299 parents and guardians recruited from 18 Head Start programs took part in the survey study. The 18-item Early Intervention Parental Awareness Questionnaire was utilized to assess the participants’ level of awareness. Results: The results of this study suggest face-to-face interaction is needed to increase awareness of services for early childhood intervention amongst the Hispanic population. Conclusion: These findings support the need for increasing recognition of the value of early intervention for children with communication disorders amongst the Hispanic population.

A Match Made in Heaven: Exploring Views of Medicine Students, Pharmacy Interns and Facilitators in an Interprofessional Medicines Pilot Study

Purpose: To date, few interprofessional education initiatives have included just medicine and pharmacy learners. This research sought to explore learners’ and facilitators’ views of an interprofessional education medicines pilot study involving medical students and pharmacy interns. Methods: Qualitative feedback was gathered from the participating learners and a facilitator focus group was undertaken. Results: Medical student and pharmacy intern learners reported enjoying taking part and found the simulation and overall initiative to be authentic. They described learning most about each other’s roles and responsibilities and about teamwork, collaborative management, and collaboration. Some logistical improvements were suggested. The facilitators judged that the topic of medicines, with medical and pharmacy learners taking part, to be a match made in heaven. Conclusions: Medical student and pharmacy intern learners found the medicines topic and discipline grouping facilitated their learning. Some topics and groups of disciplines are ideally matched for IPE and such a nexus should be capitalised upon.

Increasing Physical Activity In Older Australians to Reduce Falls: A Program Evaluation

Purpose: As people age, they are at greater risk of injurious falls. Falling has a significant impact not only on the individual but also the wider community. Undertaking physical activity is effective in reducing the rate of falls in this population. Therefore, providing targeted education during group-based falls prevention programs may increase the awareness and amount of physical activity older people undertake to assist in reducing their risk of falling. Methods: A longitudinal cohort design involving a pre-post intervention survey was conducted over an eight-month period with community-dwelling older adults who participated in a fall-prevention program. Participants were N = 161 (123 female and 38 male), aged 65 years and over, with the most common age bracket being 75 to 84 years. Demographic information was collected at baseline. It included falls history and self-reported physical activity levels. Immediately post-intervention, self-reported changes in the awareness of the role of physical activity and awareness of falls risks were measured. Six months post-intervention, participants self-reported their physical activity levels and post-program fall history. Results: An increase in awareness of the role of physical activity in reducing falls risk as well as falls risk factors was reported in most participants after completing the program. Despite this, only around a third of participants increased their physical activity levels during the six months after the program even though a decrease in falls rates was noted. Conclusions: The targeted education within the falls prevention program demonstrated an increase in awareness of falls risk factors and the importance of regular physical activity to minimise the risk of falling. However, this awareness did not seem to result in an increase in the amount of physical activity participants undertook after the program, even though falls rates across the participants reduced. Further research is needed to explore why older people who understand the benefits of undertaking regular physical activity did not increase their activity levels.

Group Physiotherapy for Treatment of Pelvic Floor Dysfunction: A Consumer’s Perspective

Introduction: Level 1 grade A evidence exists to support physiotherapy as a first line treatment of women with stress urinary incontinence and pelvic organ prolapse (POP). A novel way to provide care for women with pelvic floor dysfunction in a tertiary hospital setting is to mandate attendance at an introductory group education session prior to offering an individual physiotherapy consultation. There is minimal research to date examining the consumer perspective of group physiotherapy for treatment of pelvic floor dysfunction. This study aims to evaluate the consumer experience with a view to determining if this model of care meets the needs and expectations of the consumer. Objective: To evaluate the consumer perspective of an educational and practical pelvic floor class prior to offering an individual physiotherapy appointment for women with pelvic floor dysfunction. Method: Over a 6-month period, 39 women completed a voluntary, anonymous survey to evaluate their experience of attending a physiotherapy pelvic floor class. Results: Respondents reported that the information delivered was appropriate, relevant, and engaging and felt more informed and less alone in their symptoms after attending the pelvic floor class. Women reported that they had received the necessary education and practical skills required to begin implementing practical changes that addressed their pelvic floor dysfunction. Conclusion: By providing a consistent, informative, and practical group session for women referred with pelvic floor dysfunction as a baseline entry point to individual care, treatment can be commenced that is acceptable to the consumer. The acceptability of this method of service delivery serves as a basis for further important research evaluating the efficiency and effectiveness of group physiotherapy treatment.

Designing a 3D Printed Prosthetic to Meet Task-Specific Needs: A Case Study

The purpose of this case study is to explore the ease of utilizing task-specific design in computer-aided, open-source 3D printed design software. Two participants were recruited and assessed using subjective and objective measures to guide the prosthetic designs. Hand measurements were obtained and entered into computer software to create computer-aided design drawings of the digit prosthetics. Field notes were taken throughout this process by the interdisciplinary team and analyzed to address the ease of utilizing this technology. Objective assessments showed that both participants experienced decreased expansion, grip, and prehension strength of their affected hands. Semi-structured interviews with the participants identified several meaningful tasks that a prosthetic device could improve function in and offered valuable guidance in the development of the prosthetic designs. Analysis of the field notes allowed for the identification of six domains within the research questions. Those domains include appropriate assessment utilization, time management, participant responsiveness, clinical reasoning, common language, and available resources. The successful collaboration of occupational therapy (OT) and engineering disciplines resulted in customized 3D printed finger prosthetic designs to meet participants' specified tasks.

Addressing Health-Related Myths in the Culturally Diverse African American Population: A Call to Action

African Americans (AAs) experience numerous challenges that socially, economically, and physically affect their communities. Recent studies have found that a diverse array AAs encounter many struggles as they navigate the United States (U.S.) healthcare system to access care and receive healthcare services. AA communities are significantly affected by the burden of chronic diseases. They face considerable barriers to healthcare services that contribute to adverse health outcomes. This paper explains the daily struggles many AAs face within their communities to access and navigate the healthcare system due to culturally held myths and barriers. This paper discusses commonly held myths among Afro-Caribbean and West Indies populations living within the state of Georgia to suggest a call to action to address health disparities in this population.

Agreement in Walking Speed Measured Using Four Different Outcome Measures: 6-Meter Walk Test, 10-Meter Walk Test, 2-Minute Walk Test, and 6-Minute Walk Test

Background: Walking speed is considered the sixth vital sign because it is a valid, reliable, and sensitive measure for assessing functional status in various populations. Purpose: The current study assessed agreement in walking speed using the 6-meter walk test, (6MWT) 10-meter walk test (10MWT), 2-minute walk test (2minWT), and 6-minute walk test (6minWT). We also determined differences in walking speed. Methods: Seventy-three healthy adults (44 females, 29 males; mean [SD] age=31.36 [10.33] years) participated. Lafayette Electronic timing devices measured walking speed for the 6MWT and 10MWT. Measuring wheels and stopwatches measured walking distance and speed for the 2minWT and 6minWT. Participants completed 1 trial, and all tests were administered simultaneously. Results: The intraclass correlation coefficient (2, 4) for the different measures of walking speed was excellent at 0.90 (95% confidence intervals, 0.86-0.93). The correlation was 0.95 between 6MWT and 10MWT, 0.94 between 2minWT and 6minWT, 0.67 between 6MWT and 2minWT, 0.63 between 10MWT and 2minWT, and 0.59 between 10MWT and 6minWT (all p < 0.05). No differences in walking speed were found between the four walking tests. Conclusion: Administration of any of the four walking tests provided reliable measurement of walking speed.

Self-Confidence and Perceptions of Athletic Training Students Following Simulated Experiences: A Mixed-Methods Pilot Study

Purpose: Athletic training clinical education provides students with a variety of real-life patient encounters under the supervision of a credentialed athletic trainer. However, clinical education experiences may not allow for all students to practice more invasive or less common skills such as rectal thermometry. The purpose of this study was two-fold: 1) determine the effect of a series of low to high-fidelity simulated rectal thermometry experiences on athletic training students’ self-confidence scores; and 2) through a phenomenological qualitative approach, explore athletic training students’ perceptions following the simulated rectal thermometry experiences. Method: This study used a quasi-experimental, mixed methods, one-group repeated measures design. Participants were nine first year professional Master of Athletic Training students who completed four simulated experiences on the skill of rectal thermometry. The outcome measures were The Athletic Trainer’s Self-Confidence Scale (ATSCS) and qualitative semi-structured open-ended interviews. Results: Friedman’s ANOVA revealed a statistically significant improvement from the participant’s baseline ATSCS scores to the last post-test scores. We identified three major themes following qualitative interviews: 1) Perception changes before and after participation; 2) Benefits of a series of four simulations; 3) Explanations for the improvements in confidence and competence. Conclusions: A series of simulated learning activities using high-fidelity and standardized patient interactions can help improve athletic training students’ self-confidence. Though future research is needed, athletic training education programs should consider implementing simulated experiences to equip athletic training students to transition to practice.

The Attitudes and Perceived Barriers Regarding the Practice of Evidence-Based Management Among Healthcare Managers in Saudi Arabia

Purpose: The study purpose was to explore attitudes and identify perceived barriers regarding the practice of evidence-based management (EBMgt) by healthcare managers. Method: A cross-sectional descriptive study was conducted using a simple random sample. The study population included middle- and lower-level healthcare managers at a specialized hospital in Saudi Arabia. A total of 165 healthcare managers were invited to complete a hard copy-survey. Results: The surveys were completed by 120 respondents, yielding a response rate of 72%. The study results showed that most of the participants had a favourable attitude towards the practice of EBMgt. However, a lack of training programmes, a lack of time, limited understanding of scientific research, and a lack of organizational support and culture for implementing the EBMgt approach were perceived as major barriers to the practice of EBMgt by the respondents. Conclusions: The findings of this study provide policymakers and healthcare leaders with baseline information about barriers affecting the adoption of EBMgt among healthcare managers. Further research to explore effective strategies that might increase the use of evidence-based approaches and reduce barriers to the adoption of EBMgt is recommended.

Empathy Levels Correlate with Practical Examination Scores in Doctor of Physical Therapy Students

Purpose: The purpose of this study was to examine if empathy levels correlate with practical examination scores in DPT students. It was hypothesized that students with higher empathy levels would receive better scores on practical examinations. Methods: Participants were a convenience sample of 49 first and second year DPT students from Franklin Pierce University in Goodyear, AZ. After obtaining informed consent, participants completed the Interpersonal Reactivity Index (IRI) to assess personal empathy. These scores were compared with participants’ practical examination scores using a Spearman Rho statistical test with data analysis completed using SPSS software. Results: 49 participants (26 females, 23 males) with mean practical examination score (92.5% ± 0.02) and mean empathy score (72.80 ± 18.66). Spearman Rho correlation (rs = 0.864, p < 0.000). Conclusions: A significant positive correlation between empathy and practical examination scores in physical therapy students was found. Educators can use these findings to provide resources to students to assist with practical examination performance.

“Where I am weak, they are strong”: Students’ Perceptions and Attitudes Toward Interprofessional Education

Purpose: Healthcare professionals strive for interprofessional practice to achieve optimal patient care. Extant research suggests that to best prepare students for interprofessional practice, interprofessional education (IPE) should be a key element in curriculum. The purpose of this mixed-methods study was to evaluate the impact of an IPE activity on participants’ attitudes and perceptions of IPE across five academic programs. Methods: This study utilized a modified version of the Readiness for Interprofessional Learning Scale Questionnaire (RIPLS) pre and post IPE and reflective essays. Participants included 67 students from nursing, occupational therapy, athletic training, dietetics, and speech-language pathology programs. After reviewing a hypothetical case study, participants collaboratively developed assessment and treatment recommendations. Questionnaires were analyzed using statistical procedures and reflective essays underwent thematic analysis. Results: Collectively, data revealed significant changes in participants’ perceptions, attitudes, and implementation readiness. Occupational therapy student participants had statistically significant increases in the RIPLS composite score, Teamwork and Collaboration, and the Positive Professional Identity components (p≤0.03). Participants with previous IPE experience scored 4-points higher on the RIPLS composite score (p=0.03). The reflective essays revealed the themes of barriers associated with collaboration, a deeper understanding and appreciation of other discipline’s roles and the value of teamwork in achieving optimal patient care. Participants reported beginning the interprofessional education experience with anxiety and uncertainty about not only their involvement but also the roles of other healthcare professionals. Throughout the experience, participants emerged with an increased knowledge of their role, others’ roles, and the value of working together within a professional setting to achieve the same goal, optimal patient care. Conclusions: Our findings reveal the benefits of interprofessional education and the necessity to include several healthcare professionals associated with rehabilitation in interprofessional research and education. With more disciplines represented, students receive a broader, more in-depth understanding of not only patient care but also the roles of multiple disciplines they will collaborate with during actual rehabilitative practice.

The Impact of Perfectionism on Mental, Social, and Physical Health of Graduate Students in the Health Sciences

Purpose: Perfectionism is considered a multidimensional construct with adaptive and maladaptive features. It was hypothesized that the diverse perfectionism components would predict well-being outcomes of similar valence. Method: The current study investigated perfectionism and mental, social, and physical health outcomes of graduate students in health science disciplines, across two semesters. We utilized two approaches in our empirical analysis. We first examined the continuous relationships between perfectionistic strivings, perfectionistic concerns, and health-related outcomes of graduate students. Additionally, we assessed differences between three perfectionism groups (i.e., adaptive, maladaptive, or non-perfectionist) on these well-being outcomes. Results: Results indicated that generally, adaptive perfectionism was related to better mental health, quality of life, and social functioning; maladaptive perfectionism was related to worse outcomes. The groups, however, did not statistically differ in general physical health. Conclusions: Overall, our results support a conceptualization of perfectionism that is differentially related to graduate student well-being. Thus, supportive networks may be fostered by differentiating between adaptive and maladaptive features of perfectionism. Moreover, we highlight the need for further discussion relative to determining perfectionism in high-achieving populations, in particular, graduate students in the health sciences.

Implementation and Assessment of a New Program Requirement to Promote Professional Development

Purpose: Requiring students to complete and record professional development type activities similar to the requirements of certified athletic trainers may help promote the values and behaviors associated with life-long learning in the evolving practice of athletic training, as well as prepare students more practically for the expectations of credential maintenance. We sought to design, implement, assess, and improve a new professional development program requirement in a professional-level athletic training program that closely mirrored the process and re-certification requirements for certified athletic trainers. Methods: a quasi-experimental mixed-methods approach was used. Data were collected over two consecutive years at a private university in the Midwestern United States. A convenience sample of students enrolled in a professional athletic training program participated in the study. Student-rated perception of the new professional development requirement and qualitative student perceptions were mined from various data sources. Results: Participants in the study reported positive, self-reported progress toward achieving program outcomes. Major benefits as identified by the participants included socialization opportunities, exposure to emerging practices and techniques, and appreciation of the process for credential maintenance. Feedback given by students was integrated into the professional development program requirement where appropriate between years one and two of the study, and changes were received well by participants. Conclusions: Athletic training students in the current study benefitted from participation in overt pedagogy in professional development. Establishment and cultivation of a professional development requirement may benefit athletic training programs for the best preparation of athletic trainers before they transition to practice.

Self-Reflection and its Relationship to Occupational Competence and Clinical Performance in Level II Fieldwork

Purpose: Reflective practitioners embody the ability to critique their own clinical thinking about the dilemmas that frequently arise in professional practice and everyday life. Conflicting evidence exists on whether or not self-reflective practices are effective in promoting academic, clinical, and personal success. This quantitative study investigated self-reflection as a predictor of increased occupational competence and clinical performance in Level II Fieldwork for entry-level Master's degree occupational therapy students. Method: The study used convenience sampling to recruit participants and data were collected via a demographic survey and self-assessment questionnaires. Multiple linear regression analyses were conducted to determine the extent to which self-reflection predicts occupational competence and clinical performance. R2 values were examined to determine the importance of each dependent variable (occupational competence and clinical performance). Results: Findings revealed a statistically significant relationship between self-reflection and occupational competence (p = 0.0053) but not between self-reflection and clinical performance (p = 0.08). Self-reflection accounted for 14% of the variance in clinical performance (R2 = 0.14), and more than one third (R2 = 0.38) of the variance in occupational competence. Results suggest that students who self-reflect regularly during fieldwork may have a greater ability to maintain everyday life routines during the demands of Level II Fieldwork. Conclusions: Self-reflection strongly predicts occupational competence of occupational therapy students during Level II Fieldwork, but does not significantly predict students’ clinical performance. Recommendations: Occupational therapy educators should consider incorporating guided self-reflection activities into the academic program in order to support student occupational competence. Intentional coaching in self-reflection may better prepare students for a clinical setting by supporting healthy daily routines, which may help them to manage stress during Level II Fieldwork. Future research should explore the impact of self-reflection training during clinical rotations (provided by clinical educators) on student clinical performance. Revision of the measurement of clinical performance is warranted to include questions pertaining to soft skills such as self-reflection and awareness.

Relationship Among Emotional Intelligence and/or Extrovert Bias on Perceived Stress Levels in DPT Students

Purpose/Hypothesis: Students in graduate level DPT programs function at varying levels. Some students thrive and others struggle to maintain required minimum levels of academic performance. When considering admission of applicants, and when assisting enrolled students, consideration of factors contributing to academic success is of interest. Stress has been shown to be prevalent in a wide range of students and has many negative effects including poor life satisfaction, increased clinical burnout, and reduced academic performance. Research has shown a correlation between higher emotional intelligence (EI) and decreased stress levels in medical, nursing, and undergraduate students. The purpose of this study was to examine if emotional intelligence (EI) and/or extrovert bias correlates with perceived stress levels in Doctor of Physical Therapy (DPT) students. It was hypothesized that students with higher emotional intelligence and more extroverted personalities would experience lower levels of perceived stress.

Participants: After providing consent, a convenience sample of 60 first and second year DPT students (33 female) with age range 23 to 38 participated in the current study. Participation was voluntary and 60 of a possible 72 students chose to participate.

Materials/Methods: After obtaining informed consent, participants completed Goldberg’s IPIP-Neo questionnaire (extraversion), Perceived Stress Scale (PSS) and Assessing Emotions Scale (emotional intelligence). Each of these tools have demonstrated validity and reliability for the respective areas measured. Surveys were administered to students and results were analyzed for possible relationships between extraversion and stress levels as well as EI and stress levels using a Spearman Correlation test.

Results: Spearman Correlation analyses were conducted with a significant negative correlation between EI and perceived stress rs = -0.291, p= 0.026 and a non-significant negative correlation between extraversion and perceived stress rs = -1.36, p= 0.305.

Discussion: In the current sample, EI had a significant negative relationship with perceived stress levels, with higher EI scores correlating to lower levels of stress. The relationship between extraversion and perceived stress was non-significant.

Clinical Relevance: Doctorate level graduate programs can be considered intense and very stressful. Admission of qualified students equipped to meet the demands of a DPT program has great importance. Establishing a correlation between EI, introversion/extraversion bias, and stress may help DPT programs further assess prospective students. Consideration of factors correlated with higher perceived stress may be useful when providing resources to admitted students to facilitate academic success.

Feeding Difficulties in Children: A Guide for Allied Health Professionals An Evaluation Report

Purpose: An evaluation of Feeding Difficulties in Children: A Guide for Allied Health Professionals (2016) was undertaken to determine how the publication has been utilised amongst allied health professionals across NSW. This evaluation aimed to identify the usefulness of the Guide in supporting the assessment and management of children with feeding difficulties. Results will inform future education and support strategies. Method: The evaluation targeted allied health professionals employed by NSW Health. An online questionnaire formed the primary method of data collection. Four semi-structured focus groups also occurred to provide complementary qualitative information. Results: Clinicians from a range of professions and healthcare settings responded to the online questionnaire (N=100) and participated in focus groups (N=15), reflecting the range of allied health professionals who work with children with feeding difficulties. Qualitative and quantitative data obtained identified a number of key themes. The data collected provided a robust overview of how the Guide has been utilised. The main findings relate to five key themes: characteristics of respondents and their teams; use of the Guide; knowledge of content; satisfaction with the Guide; and future directions. Conclusions: The evaluation indicated that the Guide is viewed as a useful tool by allied health professionals working with children with feeding difficulties. Experienced respondents reported that the Guide provided validation for current practice whereas those with less experience indicated it supported their work within this clinically complex realm. Further promotion of the Guide and multi-modal education regarding its use is recommended.

Assessing Participant Feedback to Dental Screenings Provided by Dental Hygiene Students and Follow-up Dental Hygiene Care in New York City

Objectives: The purpose of this study was to validate the association between dental screenings and follow-up care to support the level of awareness of dental hygiene services available in the community by increasing access to care and determine patients’ knowledge of dental insurance status. Methods: A first-time dental screening was conducted, and complimentary care was provided for those who followed through with dental hygiene care at the clinic. Survey questionnaires were administered to participants following screening and clinic care. Results: Ten participants of the 50 screened received care at the clinic. Less than half of those screened (41 %) had a dental visit over a year ago. Most participants were not aware of the low-cost dental services available. Twenty percent (20%) of participants did not know if they had dental insurance coverage. Conclusions: Dental screening participants are likely to schedule an appointment for dental services. Raising awareness of low-cost dental care services available in the community by offering screenings at local events may increase access to care.

Cost Outcomes of Physical Therapist Providers Compared to Primary Care Providers in the Treatment of Musculoskeletal Patients in a Military Treatment Facility: A Retrospective Chart Review”

Purpose: The purpose of this study was to compare the cost of physical therapist (PT) management of patients with musculoskeletal (MSK) disorders to management by traditional primary care managers (PCMs); medical doctors (MDs), doctors of osteopathic medicine (DOs), advanced registered nurse practitioners (ARNPs), and physician assistants (PAs). Methods: This is a retrospective study of electronic medical records using an exploratory, non-experimental, cross-sectional, and quantitative design method. The records of patients with MSK disorders were assessed at an Air Force military medical clinic for 18 months from January 2016 through June 2017. Results: PT management of MSK patients resulted in a significantly lower rate of imaging studies, NSAIDS, and cost of care when compared to MDs, DOs, PAs, or ARNPs. Patients with MSK disorders managed by PTs had no significant difference in return-to-work rate when compared to MDs, DOs, PAs, or ARNPs. Conclusions:The military model of physical therapy direct access care has been shown to be cost effective when compared to care provided by traditional primary care managers.

An Audit of the Use of Simulation in Australian and New Zealand Physiotherapy Curricula

Purpose: The aim of this exploratory research was to investigate the use of simulation in physiotherapy curricula across Australia and New Zealand. The key areas of focus were whether simulation was being used, the forms of simulation used for training and assessment, evidence for educational simulation practices, and the enablers and barriers to implementing simulation into the curricula. Method: All Australian and New Zealand Universities offering a physiotherapy degree were invited to participate in an electronic survey. As no pre-existing tool was available to answer the aims of the study, a custom designed survey was developed. The survey was pilot tested on three physiotherapy academics to limit ambiguity and ensure the questions directly related to the purpose of the study. An introductory invitation was circulated via the Council of Physiotherapy Deans Australia and New Zealand. Open and closed ended questions were analyzed following a sequential explanatory strategy. Results: Fourteen (14) of the possible 22 universities (64%) responded, with all indicating that they use simulation for training or assessment and many using it for both. All core areas of clinical practice were represented, as were low to high-fidelity forms of simulation. Role play (77%), low/medium fidelity manikins (77%), and standardized patients (62%) were the most frequently used for training. Role play (73%), standardized patients (45%), objective structured clinical examinations (45%), and low/medium fidelity manikins (37%) were the most frequently used modalities for assessment. The key enablers appear to be availability of equipment, academic support, growing evidence for its use, safety, and positive student experiences. The key barriers appear to be time, cost, and access to trained staff and equipment. Conclusions: Academics across Australia and New Zealand described simulation practices for both training and assessing physiotherapy students. Academics were able to identify a limited but expanding evidence-base for simulation, more strongly focused on training than simulation-based assessments. Recommendations: Further research may justify increased investment of time, money, resources, and training in different simulation modalities.

Interprofessional Education at a Distance: The Hybrid Interprofessional Education Model

Background: Interprofessional education (IPE) is a critical component of health professions education but planning and implementation are challenged by logistical, physical, personnel, and recently global pandemic COVID-19 barriers. Purpose: This report describes the development and design of the proposed Hybrid Interprofessional Education (HIPE) model, a blended learning IPE model developed to mitigate barriers using a flexible framework and online collaborative technologies to deliver experiences based on Interprofessional Education Collaborative (IPEC) core competencies. Operational principles, model design, an example of model implementation, and outcomes are reported. Method: Fifty-four student physical therapists and physician assistants attending remote campuses of the same university participated and completed an exit survey. Descriptive statistics were calculated for Likert scale and semantic differential scale survey items and thematic analysis was conducted for open question responses. Results: Analysis revealed students felt improved understanding of interprofessional practice, the other profession’s role, teamwork, and communication. Responses supported online, asynchronous delivery and the web application used but not the synchronous activity portion. Three themes arose from comments: learning with and from, interactions, and activity design. Conclusion: The HIPE model was used to deliver IPE that supported perceptions of student learning in IPEC core competencies when physical proximity was not possible. Further iterative research and model refinement are needed. Future research should include investigation of student learning outcomes when using the HIPE model.

Therapeutic Management of a Patient with Necrotizing Fasciitis Resulting in Quadrilateral Amputation and Critical Illness Myopathy in the Intensive Care Setting: A Case Report.

Purpose: The purpose of this case is to illustrate the best available evidence to provide early therapeutic intervention for a critically ill patient presenting with cardiovascular and pulmonary complications due to multi-system compromise. Case Description: A 19-year-old male was admitted to the hospital with the diagnosis of necrotizing fasciitis and necrotizing pneumonia. He experienced numerous additional medical complications ultimately leading to tracheostomy, delirium, critical illness myopathy, and quadrilateral amputation secondary to necrotizing fasciitis and critical limb ischemia following prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO). Outcomes: Patient was discharged to an outside rehabilitation hospital after 103 days in the acute setting (56 days in the ICU) and was able to tolerate 40 minutes sitting edge of bed with supervision, perform bed mobility with supervision, and propel a standard wheelchair up to 50 feet independently. At 10 months’ post-discharge from the acute setting, the patient was ambulating independently up to 150 feet without assistive device using bilateral lower extremity prosthetics, able to propel a lightweight wheelchair community distances, independent in all transfers, and returned to school and work. Discussion: These findings suggest that clinicians may want to consider examining and combining the best available evidence of multiple medical conditions to provide a well-rounded therapeutic approach including but not limited to, close monitoring of vitals and early mobilization, to managing complex patients in the intensive care setting.

Mindfulness Training and Practice in Physician Assistant Education

Purpose: The purpose of this study was to integrate mindfulness, as a compassionate pedagogy, into a physician assistant (PA) program and assess its effects on student depression, anxiety, and stress at the conclusion of the first semester. Method: Fifty-five of 60 first-semester students provided consent. Mindfulness instruction and practice began with a six-hour intensive workshop spread over two days during the first week of the semester. This was followed by seven, brief, 10 to15 minute mindfulness practices integrated across one course. Students completed a demographic questionnaire at the beginning of the project and the DASS 21 survey which measures a range of symptoms common to depression, anxiety, and stress at weeks 1 and 16 of the semester. After the course concluded, 10 students were randomly selected from those who had identified as interested in participating in a focus group to discuss their experiences and offer suggestions for improvement. Results: DASS 21 subscale scores revealed no change in depression, anxiety, nor stress. In contrast, the focus group results revealed that student anxiety and stress levels diminished through learning about mindfulness and practicing mindful meditations. Conclusions: The incorporation of mindfulness training was generally well received by first-semester PA students. Students in the focus group reported decreased levels of anxiety and stress, while the DASS 21 revealed no change. The authors suggest that the experience could be strengthened by modifying the workshop material and extending the mindfulness practice across the didactic and clinical years to allow students more opportunities to develop their personal mindfulness practice and integrate it throughout their career.

The Effects of Blood-flow Restriction Training on Muscle Hypertrophy, Strength, and Power in College-Age Adults

Purpose: Low load BFR (LLBFR) training can produce similar strength gains as high load resistance (HLR) training, especially in cases where persons may not have the ability to toelrate heavy loads. The purpose of this study was to compare changes in strength, power, and hypertrophy between HLR (70% 1RM) and LLBFR (30% 1RM). Methods: Sixteen healthy individuals, ages 23-21 (8 male, 8 female) were randomized into HLR and LLBFR groups. Obtained baseline measurements included 1-repetition maximum (1RM), thigh circumference, and vertical jump height. Each group performed back squat, Bulgarian split squat, barbell step ups, and lunges. The HL group trend 3x weekly at 3 x 8 repetitions with 2-3 minutes rest and the LLBFR trained 2x weekly for repetitions of 30-15-15-15 with 30 seconds rest between sets and 2-3 minutes rest between exercises. Results: Significant differences were found within groups for pre-post vertical jump height, left thigh circumference, and 1RM squat. No significant difference was found between LLBFR and HLR groups in measures of vertical jump height or 1RM squat. Conclusion: LLBFR using compound, closed kinetic chain exercises may be effective for strength training in persons who may not be able to tolerate higher loads.

Students’ Retention of Biophysical Agents Curriculum from First to Third Year of Study

Purpose: Biophysical agents (BPA) are widely used in physical therapy clinical practice and is a content area included in entry level physical therapist education programs. Retention of this content is critical for clinical practice. The purpose of this study was to measure to what extent 3rd year physical therapist students (PTS) were able to recall knowledge of BPA content after a 2 -year gap by repeating an examination that was given during the first year. Specifically, 1) Is there a significant difference in retention of BPA content/material between the 1st and 3rd year of curriculum, and 2) Does exposure/use of BPA during a clinical education experience (CEE) affect retention of material? Methods: A sample of convenience of 22 current 3rd year PTS who completed a BPA course during their 1st year participated. The comprehensive written examination for the BPA course served as the test instrument to determine knowledge retention. The PTS re-took this exam in their 3rd year of study, after completing their 2nd CEE. The PTS also completed a questionnaire soliciting information about demographics and degree of exposure to BPA during their CEE. A paired t-test was used to compare 1st year and 3rd year total test scores. The PTS were divided based on BPA exposure during their CEE, and test scores were compared using an independent samples t-test. Results: There was a significant decrease in test score from 1st to 3rd year (first year was 89.5% (range: 97.0% - 80.0%) while the 3rd year was 52.1% (range: 39.0% – 67.0%). There was no significant difference (p=0.561) in mean test scores on the 3rd year test for PTS with BPA exposure during CEEs (52.6%) vs those that did not (50.4%). Conclusions: Like other health professions, there was a decrement in knowledge retention. Results indicate a significant loss of retention of BPA knowledge when provided a 2-year gap, which was unaffected by exposure to BPA during CEEs. Exploring methods to improve knowledge retention in BPA curriculum may be needed. Future research should investigate retention with other methods of instruction including those that incorporate more active learning methods.

Keywords: biophysical agents, students, retention, modalities

Making it Work for Everyone: Developing Flexible Digital Clinical Communication Modules for Health Disciplines in an Australian Context

Purpose: This paper discusses an innovative multi-disciplinary approach to the development and evaluation of flexible, digital clinical communication learning resources to support students in twelve health disciplines to develop clinical communication skills in preparation for their clinical placements. Methods: A modified Delphi survey was sent to all stakeholders in the Division of Health Sciences to identify the most important communication skills from the list of 61 communication skills identified by Bachmann et al in 2013. Lecturers, clinical educators, clinicians, and students were invited to rate the importance of each skill. Results: A set of digital resources was created for teaching clinical communication to students across all years and disciplines and for use by clinical educators in the Division to prepare students for clinical placement. In addition, an effective methodology for course development, involving broad consultation and multi-disciplinary development teams comprised of clinicians and other educational experts, was developed. The resources were implemented in two disciplines, podiatry and midwifery, and evaluated pre- and post-placement using a qualitative and quantitative method developed with the course coordinators. Conclusions: There are identifiable clinical communication skills which are applicable across numerous health disciplines and as for other learnable skills, teaching can be enhanced by breaking them down into specific, demonstrable elements which students can observe and practice. Using the pedagogy and methods outlined in the paper, students demonstrated increased awareness of the importance of communication in the clinical context, and the capacity to evaluate their performance of those skills.

Do Learning and Study Strategies Predict Success in Hybrid-Online Physical and Occupational Therapist Education?

Purpose: An understanding of the learning strategies most accurately predictive of success has become increasingly important as health professional education programs scale the utilization of online learning in the wake of COVID-19. The purpose of this study was to examine the predictive relationship between The Learning and Study Strategies Inventory (LASSI) and cumulative professional GPA (cpGPA) in hybrid-online physical (PT) and occupational therapist (OT) education. Methods: A convenience sample collected N=149 entry-level PT and OT students from three campuses across Florida, Texas, and California. A total N(%) of 89(59.7%) PT and 60(40.3%) OT students were included for analysis [48(32.2%) male; 101(67.8%) female]. A cross-sectional and predictive correlational study design was utilized. Participants self-administered the LASSI and cpGPA was collected in Spring 2020. Standard multiple linear regression analyses were conducted. Results: Neither the LASSI scales, R2 = 0.05 [F(10, 138) = 0.71, p = 0.71], nor the LASSI components, R2 = 0.01 [F(3, 145) = 0.56, p = 0.64], were able to accurately predict cpGPA. These findings contradict many prior studies in health professions education where anxiety, attitude, motivation, test strategies, and time management have been significant predictors. Conclusion: This study should be repeated due to a threat to internal validity, the COVID-19 pandemic, which may have influenced outcomes to an unknown degree. The predictive nature of this measure under more natural conditions remains unknown for this population of learners.

Genomic Education – Bench to Bedside: A Novel Approach to Teaching Genetic Diagnosis

Problem: Teaching genetic diagnosis is required in all medical schools and physician assistant programs. However, with thousands of relevant findings and thousands more rare diseases, lectures and narrative resources are inadequate for the task. Whatever information that is taught is easily forgotten and does not carry over into the clinic. Many rare disease patients suffer through “diagnostic odysseys” (3 to 30 years to correct diagnosis). Approach: We used a commercially available diagnostic decision support system (DDSS) that encompasses all Mendelian disorders with known genes, together with other conditions in their differential diagnosis, and a case-based educational approach to teach diagnostic skills in a way that could then be replicated in the clinic. After a lecture, which included a demonstration using the DDSS with a sample case, 74 students were assigned to replicate the sample case at home and then complete 7 other anonymized cases, all with known rare diagnoses. After each case, students saved the “patient summary” that included the findings entered and differential diagnosis list and submitted it as homework. Students also completed a questionnaire about their experience, including satisfaction. Outcomes: Students were effective at diagnosing rare diseases in 483 of the 514 testing instances, a 94% success rate, with success defined as the correct diagnosis being listed in the differential diagnosis. Eighty-five percent of students rated this interactive learning session “highly,” encouraged us to repeat the assignment next year, and 89% reported that they wanted to use the DDSS during their clinical rotations in the coming year. Next Steps: We plan to refine the cases, add more material on findings, and ensure that all the synonyms students might use are in the software tool. We plan to repeat the program next year and recommend its use more widely in medical education.

Advanced Practice Provider Onboarding Support Model Comparison: Is there a Superior Choice?

Health care practices and institutions are providing variable onboarding models to prepare physician assistants (PAs) and nurse practitioners (NPs) for transition into new practice settings. With the evolution of healthcare delivery and increased opportunities for PAs and NPs to specialize in advanced practice environments, there has been a growing demand for an evidenced-based strategy, structure, and appraisal of content within existing onboarding models. The aim of this paper is to compare two onboarding models for Advanced Practice Providers (APPs): postgraduate training programs and traditional institutional transition to practice programs. With expanding numbers of postgraduate training programs offered nationally and increasing numbers of PA and NP graduates seeking out these opportunities calls into question the differences offered through each model. Postgraduate training programs appear to provide a consistent structure of comprehensive curriculum design, interprofessional learning, meaningful institutional engagement, leadership exposure, and support a superior onboarding support model for PAs and NPs.

Rapid Transition of an Allied Health Clinic to Telehealth During the COVID-19 Pandemic: Satisfaction and Experience of Health Professionals, Student Practitioners, and Patients

Purpose: With COVID-19 social distancing measures requiring a shift in how healthcare is delivered, telehealth service provision allows patients to receive care remotely while adhering to relevant safety regulations. This study investigated the perceptions and experiences of allied health practitioners and their patients at a multidisciplinary allied health clinic that rapidly transitioned to telehealth service delivery. Method: Allied health practitioners (both qualified and student) and patients were recruited during the transition to telehealth across a large healthcare facility located on the Gold Coast, Australia. Participants were surveyed after each telehealth session rating their satisfaction and experience across four areas (technical, administrative and operational, privacy, communication). Descriptive statistics were used to express categorical variables and a chi-square test of independence was applied to determine the presence of any associations. Results: Surveys (n=197) were collected from allied health practitioners (n = 31) and their patients (n = 70). Overall, high levels of satisfaction and experience with telehealth among patients and a consensus in satisfaction and experience among exercise physiology, physiotherapy and psychology practitioners were reported. Speech pathology student practitioners rated their satisfaction and telehealth experience significantly (p < 0.001) lower than other disciplines. A significant relationship [χ2 (2, n = 127) = 7.49, p = .02] between student practitioners and the impact of telehealth on achieving session goals and outcomes was also identified. Conclusions: This study highlights complexities related to the acceptability and adoption of telehealth, technical aspects, and user functionality which contribute to the growing body of evidence supporting digital health technologies in the delivery and access to allied health services. In a multidisciplinary context, this study advocates for the consideration of discipline-specific issues when designing and implementing digital health services.

Association Between Anthropometric Factors and Balance Among Elderly Fallers and Non-Fallers: A Cross-Sectional Study

Purpose: Falls are an emerging public health problem causing a cascade of medical, functional, and socio-economic consequences. Apart from other widely explored risk factors affecting balance, anthropometric factors are also known to have an impact on balance. However, this relationship hasn’t been studied extensively in older adults. This study aimed to evaluate the relationship between the anthropometric factors such as Body Mass Index (BMI), Body Fat Mass (BFM), Waist-Hip Ratio (WHR), Lower Limb Length (LLL), Foot Length (FL) and balance in the elderly among fallers and non-fallers. Method: This cross-sectional study was performed on 100 fallers and 100 non-fallers, aged 60 years and above. These participants were recruited by a stratified random sampling technique from Navi Mumbai region. All the above anthropometric factors were measured and recorded. Each participant’s balance was assessed using the Mini-BESTest scale. Obtained scores were analysed in SPSS software; descriptive statistics, Spearman correlation coefficient, and Z scores were applied. Results: A sample size of 100 non-fallers, 50% male and 50% females, participated in this study. Among those participants classified as “fallers,” 56% were males and 44% were females. The mean age of the non-fallers was 66±5.01 and the mean age of the fallers was 67.72±6.73.  In fallers, WHR showed good negative correlation (r= -.807), BFM as moderate (r= -.577) and BMI as fair (r= -.426) whereas in non-fallers, BMI showed moderate (r= -.546) and fair negative correlation for both WHR (r= -.303) and BFM (r= -.441). However, LLL and FL in both groups show little or no correlation. The Association of all anthropometric factors with the balance between fallers and non-fallers showed no-significant difference. It may be inter-group variance for age, gender and BMI, as participants were not matched for these variables during the recruiting phase. Additionally, the reason for the fall was not explored, thus adding to the limitations of our study. Conclusion: This study demonstrated the impact of increased WHR, BFM and BMI on balance in the elderly fallers and non-fallers. Thus, it is important to screen these factors while assessing biological risk factors for predicting falls. This study further recommends exploring the normative value for anthropometric factors in a healthy elderly population.

Comparing the Perceptions of Interprofessional Socialization Among Health Profession Students

Introduction: Based on a review of literature, there is a gap of knowledge on how students perceive the professional roles and responsibilities of other disciplines. The purpose of this study was to explore the perceptions of interprofessional socialization among health profession students. Subjects: Participants included 300 undergraduate and 114 graduate students from eight health disciplines: nursing, communication disorders, physical therapy, social work, radiological science, occupational therapy, clinical lab science, and nutritional science. Methods: Data were collected using the Interprofessional Socialization and Valuing Scale (ISVS-21). The participants rated 21 items about their beliefs, behaviors, and attitudes of interprofessional socialization on a Likert scale from 1-7, with 1 being not at all and 7 being to a very great extent. Data were analyzed using descriptive statistics and analysis of variance was conducted to compare the health disciplines for differences. Results: Descriptive analysis revealed that 95.2% of students perceived an awareness of interprofessional socialization as occurring from a fairly great extent to a great extent, with means of 5.12 or higher on the 1-7 scale. There were no significant differences between the health disciplines. Conclusion: Findings suggest that students have the readiness to understand each other’s professional roles and responsibilities. Although there are no standardized educational strategies to facilitate student collaboration between disciplines, considerations for future interprofessional collaborative activities are indicated.

Athletic Training Assessment of Knowledge Inconsistent with Perceptions of Knowledge Needs: Part II

Purpose: Continuing education (CE) is intended to promote continued competence beyond the level required for entry-level practice. Previous research suggests that athletic trainers are unable to identify their knowledge gaps regarding their clinical practice. The purpose of this research study was to determine if athletic trainers’ perceived need for CE aligns with their performance on an actual knowledge assessment. Method: We used a correlational design conducted on Qualtrics, a web-based platform. Four hundred, forty-four (444) athletic trainers completed all the CE Needs Assessment and over 60% of the athletic training assessment of knowledge. The CE Needs Assessment determined participant’s perceived need for CE using a 5-point Likert scale on the 8 content areas within the National Athletic Trainers’ Association’s educational competencies. The athletic training assessment of knowledge included 71 multiple-choice questions across the 5 domains of athletic training. Actual knowledge for each domain was determined by calculating the percent of correct answers within the domain. We used a Pearson’s correlation analysis to determine the relationship between perceived need for CE and actual knowledge for each domain. Results: We identified a poor, negative, significant correlation between orthopedic clinical assessment and diagnosis (r=-0.10, P=0.034) and domain 2 (clinical evaluation and diagnosis) total score. We also identified a poor, negative significant correlation between therapeutic interventions (r=-0.10, P=0.04) and domain 4 (treatment and rehabilitation). We identified non-significant correlations between perceived need for CE in evidence-based practice, prevention and health promotion, acute care of injury and illness, psychosocial strategies and referral, healthcare administration, and professional development and responsibility and their respective domain total scores. Conclusions: Athletic trainers are unable to consistently identify their need for CE in relation to their actual knowledge performance. This suggests that perceived need is not an effective means to identify areas of weakness in athletic training clinical practice and should not be used to guide CE choices.

An Exploration of Quality of Life Contributors for Stroke Survivors: Potential Implications for Service Delivery Within the Community Rehabilitation Context

Purpose: Community rehabilitation services typically assist stroke survivors with function, participation, and quality of life. Many factors have been found to influence the overall quality of life including self-identity, control, social supports, personality, and participation in valued activities. This review explored the possible contributing quality of life factors for stroke survivors within a community rehabilitation context to assist with further development of service delivery within this clinical area. Method: A purposive sample of clients with stroke (n=20) was selected based on their overall quality of life change during their rehabilitation program as measured on the World Health Organisation Quality of Life Questionnaire. Clients with the largest positive and negative quality of life changes were included. A clinical record review of client medical records was undertaken of these stroke survivors to identify and describe common themes that may be related to quality of life. Results: Five general themes emerged relating to possible contributing factors to quality of life for clients participating in this community stroke rehabilitation setting including transiting between hospital and community, flexibility of service delivery model, strength of family and household relationships, acceptance and expectation of both service delivery and functional levels, and ongoing co-morbid medical issues. Conclusions: This review suggests that community rehabilitation service models of care should be flexible and tailored to client needs and goals to enable a true “client-centered” approach. Social and behavioural paradigms should be incorporated within the community rehabilitation settings. Services should focus on personal factors such as the stroke survivor's adjustment to their situation, personality factors, and outcome expectations. Consideration also needs to be given to the overall continuum of care of health care services.

Empathy and Regard: Perspectives Held by Graduate Students of Rehabilitation Sciences

Purpose: Empathy and regard are understood to be critical to high-quality health care. The purposes of this study were: 1) to increase the representation of the rehabilitation sciences within the literature, 2) to refine the distinctions between empathy and regard, and 3) to examine the relation between empathy and regard within the context of two medical conditions with disparate amounts of associated stigma (cerebrovascular accident [CVA] and human immunodeficiency virus/acquired immunodeficiency syndrome [HIV/AIDS]). Method: Utilizing the Jefferson Scale of Empathy – Health Professions Student version and the Medical Condition Regard Scale, levels of empathy and regard were assessed twice in first-year graduate students of clinical doctoral programs in occupational therapy and physical therapy and a master’s speech-language pathology program, once each in the contexts of CVA and HIV/AIDS. Results: Findings indicate that students of the rehabilitation sciences have empathy levels similar to published levels for students in other health professions; empathy and regard are distinct characteristics, where when assessed in the context of a stigmatized condition, empathy was similar but regard ; and empathy and regard positively vary with one another in the context of a stigmatized medical condition Conclusions: This study suggests that there may be unmet potential for training in empathy and a need for increased education on stigmatized medical conditions to enhance regard.

Student Experiences with Engagement in a Nursing and Physical Therapy Interprofessional Education Simulation

Purpose: Interprofessional Education (IPE) incorporated into healthcare discipline instruction has been shown to be successful in improving the understanding perceptions of complimentary professions. The purpose of this mixed method study was to measure differences in perceptions of early Baccalaureate of Science in Nursing (BSN) students and Doctor of Physical Therapy (DPT) with participation in a immersive interprofessional education experience. Method: Students completed a pre and posttest survey consisting of the Readiness for Interprofessional Learning Scale and several short answer qualitative questions. Cohorts of BSN and DPT students participated in a computerized mannequin simulation experience or a hybrid simulation. Results: Students indicated they learned about each other’s scope of practice and recognized the benefits of teamwork through collaboration. Conclusion: Students showed increased knowledge of the other profession, appreciated the opportunity for interprofessional learning, and were interested in having more IPE simulation learning experiences.

An Interprofessional Approach to Teaching Evidence-based Practice

Purpose: The purpose of this mixed methods study was to identify students’ engagement and implementation of EBP competencies after exposure to EBP content in an interprofessional online research course. In this research, a diverse, convenience sample of nursing, respiratory care, and social work students were selected. The results aim to assist educators in preparing the next generation for their first professional role in providing care using the best evidence. The research questions that guided the study were: (1) What are the levels of practice, attitude, knowledge and skill regarding EBP among the sample? (2) What are the barriers and facilitators to acquiring EBP competency? (3) What are the differences in EBP attitudes, knowledge, and skills between the diverse disciplines in the sample? Methods: This descriptive mixed methods study employed a cross sectional design that allowed comparisons of programs and the different levels within the program. Quantitative data was collected using the S-EBPQ survey, allowing participants’ the opportunity to self-report on the practice, attitude, and knowledge/skills. Qualitative data was collected through two focus groups of approximately six to ten students from the three programs. Results: Data showed that students within the three selected disciplines had a positive attitude towards EBP. Theme analysis supported this view as participants noted EBP impacts patient safety and quality care. Barriers identified included, “lack of resources, use of research language interchangeably with EBP, quick exposure to EBP and confusion among EBP practices in the clinical setting.” Participants had an awareness of EBP and recognized the value of EBP. However, there may be ways to improve the implementation of EBP throughout the learning process while students are in undergraduate studies. Conclusion: Using an interprofessional online research course to introduce students to EBP was successful. Providing an interprofessional approach to teaching EBP will provide support the implementation of EBP competencies. Further development of additional interprofessional EBP courses or activities should be considered. This study found that if interprofessional care teams’ work together and use the EBP process in their courses it will improve student perceived value of EBP.

An Interprofessional Clinical Placement in a Primary Healthcare Setting: A Pilot Study

Purpose: Internationally, and in Australia, interprofessional education (IPE) is becoming typical in primary healthcare delivery and is core to delivering patient-centred care. It is essential that primary healthcare education develop interprofessional capacity in order to produce a skilled workforce. An IPE clinical placement for undergraduate health students was developed and piloted in primary healthcare settings. The aim of this study was to evaluate the impact of the IPE clinical placement in a primary healthcare setting on students’ perceptions of interprofessional education. Method: A pre-post placement validated questionnaire (n=19) indicated overall perceptions of IPE significantly increased over the course of the IPE clinical placement. Results: There was a significant increase in competency and autonomy and understanding of roles over time. There was no significant increase in the reported perception of need for interprofessional cooperation, however there was a significant increase in actual interprofessional cooperation. Conclusion: This was a successful pilot program that warrants further development and research to include longer-term follow up of students’ perceptions towards IPE and analyze whether collaboration and teamwork skills obtained during the IPE primary healthcare experience are transferrable to future professional practice.

The Utility and Value of The Physiotherapy eSkills Training Online Resource During Work-integrated learning: A mixed methods study.

ABSTRACT

Purpose: The purpose of this study was to determine the use and value of the Physiotherapy eSkills Training Online resource during work-integrated learning in naïve physiotherapy students. Method: A mixed methods study design was used. Participants: Forty-four final year physiotherapy students participating in neurological work-integrated learning units of study participated in this study. Intervention: Students had access to the Physiotherapy eSkills Training Online resource during their 6-week neurological work-integrated learning unit of study, which includes video footage and written information about 25 practical skills related to the physiotherapy management of stroke. Outcome Measures: Use of the Physiotherapy eSkills Training Online resource was examined by recording the number of hits on the resource, the number of students who accessed it, the number of times each student accessed it, and the time it was accessed. Students’ perception of the value of the resource was explored through semi-structured interviews. Results: There were 46 hits on the resource, by 13 (30%) students during the neurological work-integrated learning unit of study. Ten students accessed the resource twice or more. Double the number of hits occurred outside of work hours compared with during work hours. Qualitative analysis revealed five themes regarding the low usage of the resource by students: content of the resource; learning style; learning behavior and expectations; technical issues; and practical issues. Conclusion: Use of the resource was low, with only a small number of students using the resource on a few occasions. Value of the resource could not be clearly established.

Knowledge Levels, Attitude and Beliefs of Men towards the Digital Rectal Examinations (DRE): A study in Trinidad

Background: Trinidad and Tobago have been ranked as having one of the highest cancer mortality rates in the Caribbean. Prostate cancer was identified as the most common cancer in men, with a higher mortality than any other cancer. At least 1 in 9 men in Trinidad and Tobago will be diagnosed with prostate cancer during his lifetime. Purpose: The purpose of this study is to determine knowledge levels, attitudes, and beliefs of men aged 40 years and over regarding digital rectal examination (DRE). The investigators considered this crucial following the scourge of prostate cancer in Trinidad and Tobago and an apparent lack of the use of the DRE, a noted method of screening for the condition for early detection. Methods: A cross-sectional descriptive study was undertaken using 216 men who were at least 40 years old and who gave their informed consent; these men were attending a central mall in Trinidad in the month of April 2018 when the data was collected. Data was collected using the researchers’ designed, self-administered questionnaire and analysed using SPSS version 20. Result: Results indicate that most men (95.8%) are knowledgeable/very knowledgeable about DRE. Similarly, most (64.6%) of the men have favourable/very favourable attitudes towards DRE while 59.3% of them indicated that their beliefs have little or major influence regarding their participation in DRE. It also showed that the men’s beliefs are associated with their ethnicity (pDiscussion/Recommendation/Conclusion: The findings suggest that perhaps the attitudes and beliefs of men aged 40 years and over attending this mall are better predictors of intentions than their knowledge. This needs to be explored further given the need to curb the prevalence of prostate cancer amongst men in Trinidad and Tobago.

The Allied Health Work Readiness Study: Identifying Personal Characteristics Signalling Work Readiness in Allied Health Students

Purpose: Clinical placements associated with university degrees for the allied health professions aim to support the preparation of students for post graduate employment through the practical application of theoretical constructs. However, employers recognise that a range of generic skills and attributes outside of technical and academic achievement impact of work readiness. Allied health clinical educators within Darling Downs Health (DDH) sought to identify these generic characteristics, and their relative importance, with a view to further supporting the work readiness of students completing placements in the district. Method: The study utilised the knowledge and experience of allied health clinical educators, experienced clinical supervisors, and allied health directors, to explore the characteristics thought to be related to work readiness. Participants completed a brief demographic questionnaire before participating in one of three groups which employed the Nominal Group Technique to seek answers to the research question “What do you believe are the most important personal characteristics signalling work readiness in allied health students?” Results: Data were analysed by group and then overall, resulting in a complete list of 103 characteristics raised, 37 of which were judged as among the “most important” by study participants. Analysis revealed six characteristics which were identified and voted as among the most important by each independent group. Personal insight and self-awareness rose to the top of the list of most important characteristics, with 16 of the 18 participants voting for this characteristic, and a mean importance rating of 9.3 of a possible 10. Resilience was second on this list, followed by communication skills, organisational skills, lifelong learning, and professionalism. A further nine characteristics were selected by two of the three groups, while an additional 22 characteristics were raised and voted as among the most important by members of a single group. Conclusions and Recommendations: We believe that these results may be of interest to allied health students, allied health staff, universities and training organisations, recruiters, and managers. It is our hope that identification of these characteristics may also lead to the development of targeted education and support programs within DDH to assist students’ growth in these areas.

The Effectiveness of Kinesiotaping for Patients with Fractured Ribs: A Single-subject Experimental Design

Purpose: Kinesiotape is an elastic, adhesive tape applied to the skin that has been used extensively to reduce pain associated with various musculoskeletal conditions. Its use in the setting of fractured ribs is less clear. The aim of this preliminary study was to investigate the effect of kinesiotaping for patients with rib fracture(s) on pain levels, pulmonary function, and mobility. Method: We prospectively evaluated five patients admitted with fractured ribs using a single-subject experimental ABAB design. Each phase lasted 24 hours with kinesiotape applied during B phases. All participants received usual medical, nursing, and allied health care. Outcome measures included pain levels (participant-rated), pulmonary function, and maximum mobility. The occurrence of skin irritation was tracked. Results: Considerable variability was seen between- and within-participants for pain levels. There was some evidence, albeit inconsistent, that pain levels were lower when the kinesiotape was in situ compared to when it was not. Pulmonary function and mobility levels showed no consistent pattern between intervention phases. Skin irritation occurred in one participant and another required escalation of medical therapy for pneumonia. Conclusions: Kinesiotaping may reduce pain for patients with fractured ribs but further research, preferably randomized controlled trials with homogenous samples and standardized medication regimens, is required to confirm its effectiveness in the acute care setting.

Changing Weight Management Self-efficacy Among Obese Puerto Rican Adults: A Quantitative Study using a Health Coaching Intervention

Purpose: Obesity and associated healthcare-related issues continue to increase. The prevalence of obesity is on the rise, which has led many health professionals to find ways to improve health interventions. Health coaching can be a viable tool to reduce the obesity epidemic. The purpose of this quantitative study was to investigate the effects of an 8-weekhealth coaching intervention in obese individuals from Puerto Rico and to determine if self-esteem and body image influence weight managementself-efficacy. Method: A pretest-posttest design using a weight management self-efficacy scale helped the researcher evaluate the effectof the coaching sessions. In addition, body image was measured using the 9-figure Body Size Scale and self-esteem was analyzedwith the Rosenberg Self-esteem Scale. Forty Hispanic adult men and women participated in the study. Results: Health coaching had a statistically significant effect on weight management self-efficacy (t (39) = -6.58, p < .001). Additionally, body image and self-esteem affected weight management self-efficacy and positive health coaching outcomes were significant regardless of positive or negative perceived body image. Conclusions: These findings suggest that body image and self-esteem should be considered when creating programs for obesity and a health coaching program can be effective in increasing weight management self-efficacy.

Transforming Through Reflection: Use of Student-Led Reflections in the Development of Intercultural Competence during a Short-Term International Immersion Experience

Purpose: Curricular integration designed to include cultural competence standards for health care professionals is paramount to preparing students to meet the needs of a growing diverse population in the U.S. The purpose of this research is to examine the cultural competency development of occupational therapy students, and to report on their reflections and perspectives during a two-week immersive and service-learning experience in Guatemala. Methods: As intercultural competence is a highly personal trait, the study used a descriptive qualitative research design gaining participants’ perspectives of the short-term international immersion experience through student-led reflective focus groups, using an open discussion format, during the immersion experience. Results: Data analysis yielded three themes: Do, Experience, Understand; Change Factor; and Future Action that represent the student perspective in a cultural immersion experience. The first theme: Do, Experience, Understand encompassed participants’ discussion of how fully engaging in a culture different than their own was necessary to understand differences and commonalities. The second theme: Change Factor included expressions of dissonance in level of physical, emotional, and mental comfort that prompted a transformation within the student. The final theme: Future Action, described a tangible outcome from the immersion experience. By engaging with a different culture, participants experienced a transformation, leading to sharing of their desire to continue their advocacy efforts on behalf of others. Conclusion: Reflection became a key element in the transformative nature of the learning experience. It became obvious that a safe environment in which to share dreams, doubts, cultural missteps and successful moments was necessary for coping with feelings of dissonance. The safe sharing environment added to the cohesiveness of the group, lowered anxiety and provided opportunities for learning. Participants’ verbalized descriptions of transformative learning necessary in the development of intercultural competency during an international cultural immersion experience. By participating in a cultural immersion experience integrated into their curricular program, students began to articulate cultural competencies required to consider multiples lenses, perspectives and backgrounds of their future clients.

Opioids and an Active Population: Athletic Trainers' Perceptions

Purpose: Opioid use, misuse, and abuse are occurring in both high school and collegiate athletes. There is limited research that examines athletic trainers' perceptions of opioids. The purpose of this qualitative research study was to investigate athletic trainers’ awareness and practice of opioids in an active population. Method: Qualitative inquiry was used to explore athletic trainers' awareness of opioids in an active population. Ten athletic trainers (7 male, 3 female) employed in the Northwest Athletic Training Association (6 collegiate, 4 high schools) volunteered for this study. Phone interviews were conducted in July to September 2017 with a semi-structured interview protocol. Interview data were analyzed inductively to uncover dominant themes, first by organizing the data, then summarizing into codes, and finally interpreting. Trustworthiness included both peer review and member checks. Results: Three themes emerged from this study regarding athletic trainers' practice with opioids: 1) athletic trainers have a responsibility to their patients regarding opioids, 2) communication with patients about opioids, and 3) athletic trainer perceived a lack of education regarding opioids. Conclusions: Evidence demonstrated that athletic trainers feel they have a role with opioids and their patients. While the majority of participants in this study did discuss opioids with their patients, athletic trainers felt they were lacking knowledge of opioids. Future research should explore athletic trainers’ knowledge and education surrounding opioids and an active population.