Kathryn Elizabeth Roach

Black people in the United States have the highest rates of heart failure, and the worst outcomes of any racial/ethnic group which has been linked to both sociostructural (e.g. racism, poverty, food deserts) and behavioral factors. Physical activity is vital in managing heart failure, yet little is known about the perceptions of the Black community with heart failure. The purpose of this study was to understand and interpret physical activity engagement and the factors that may influence it in Black individuals with heart failure. This study used a thematic analysis approach. One-on-one semi-structured interviews of eight Black individuals with heart failure addressed physical activity habits, health beliefs, health literacy, medical mistrust, depression, self-efficacy, health disparities, social support, barriers and facilitators. Line-by-line coding was conducted, and themes were developed. The four key themes identified were 1. I don’t understand what heart failure is; 2. I was told that physical activity would not hurt; 3. I struggled when treated by providers from different cultures; 4. Having heart failure means I don’t have long to live. All eight participants acknowledged that physical activity was important but reported being underactive. Most could not describe what heart failure was and thus could not explain the importance of physical activity in managing heart failure. Physical activity instruction was not emphasized by healthcare providers, which likely contributed to an undervaluation of physical activity and to underactivity. Cultural differences between patients and clinicians had potential to result in non-adherence to recommendations. Healthcare providers should strive for adequate patient literacy about heart failure, and educate on the importance of physical activity, ensuring the appropriate level of instruction is provided so that Black individuals with heart failure are informed to best address their health.

Background: The aim of this study was to analyze the influence of beliefs and attitudes of practicing physical therapists (PTs) about aging on their expectations concerning the behavior and outcomes of patients with orthopedic conditions. We hypothesized that some beliefs and attitudes would be related to expectations of worse outcomes in older patients compared to clinically identical younger patients. Methods: Seventy-one (71) practicing PTs with a mean age of 40 years (±10.44, range 24–67) were recruited via snowball sampling and asked to participate in a three-part online questionnaire. For part 1, participants were randomly assigned a hypothetical case involving either a 42-year-old or an 85-year-old patient s/p surgical repair of a femoral shaft fracture. Thirty-five (35) participants were randomly assigned to the young case group (YCG) and 37 to the old case group (OCG). Participants were asked questions related to their expectations concerning the patient’s clinical and functional potential, response and adherence to physical therapy, and patient responsibility for their own outcomes. For part 2, all participants completed the Kogan Attitude Toward Old People Scale consisting of 34 paired (positive/negative) statements. Part 3 consisted of subject demographics. Results: Participants in the YCG and the OCG were similar in age (41 vs. 40 years), PT experience (16.7 vs. 14.8 years), gender (82.9% vs. 86.5% female), and positive Kogan score (69.5 vs. 68.2). The groups differed in belief the patient would return to their prior level of function. YCG believed it was “extremely likely”, while the OCG believed it was “moderately likely”. In the OCG, greater likelihood that the patient would return to prior level of function was related to stronger belief that “Most ageing adults are really no different from anybody else” (r = 0.35). Conclusion: In general, physical therapist participants in this study agreed with positive attitudes and beliefs about aging adults as measured by total positive Kogan score. The only outcome expectation that appeared to be influenced by the age of hypothetical patient was return to prior level of function. Although some specific age-related beliefs were correlated to expectation of return to prior level of function, the positive Kogan score was not. It is possible that age related differences in expectations of return to prior level of function were influenced by clinical experience rehabilitating older patients rather than negative attitudes and beliefs about aging.

Background and Aims: The purpose of this study was to compare the knowledge and practices of specialist and experienced nonspecialist physical therapists in performing patient education about physical activity with patients with heart failure (HF).Methods: Responses on a nationwide anonymous online survey were used to compare specialist and experienced nonspecialist physical therapists on knowledge and frequency of providing physical activity related education to patients hospitalized with acutely decompensated HF. Responses to survey items were scored on 5‐point scales ranging from “Strongly agree” to “Strongly disagree” or “Always” to “Never.” Mann−Whitney U statistics were used to compare specialist and experienced nonspecialist responses and Wilcoxon signed‐ranks tests were used to examine the gap between knowledge and practice.Results: Twenty‐seven specialists and 43 experienced nonspecialists completed the survey. Both groups were similar in age, and experience treating patients hospitalized with acutely decompensated HF. Both groups “strongly agree” that they had the required knowledge and skills to educate patients with HF on the physical activity topics. However, specialists more often than experienced nonspecialists provided education on topics such as how to monitor vital signs during physical activity (“most of the time” vs. “about half of the time”) that promoted patient confidence and safety during exercise. Specialists demonstrated a smaller gap between knowledge and frequency of providing patient education than experienced nonspecialists on three of the four patient education topics.Conclusion: Specialist physical therapists treating patients with HF in the inpatient hospital setting provided patient education on physical activity at a level more closely matching their skills and the clinical practice guideline than did experienced nonspecialists. Physical therapy clinical specialists practicing in the inpatient hospital setting may improve patient outcomes and lower costs to the health care system by improving physical activity adherence and thereby may reduce avoidable hospital readmissions.

A clinical practice guideline on physical therapist management of patients with suspected or confirmed osteoporosis was developed by a volunteer guideline development group (GDG) that was appointed by the Academy of Geriatric Physical Therapy (APTA Geriatrics). The GDG consisted of an exercise physiologist and 6 physical therapists with clinical and methodological expertise. The guideline was based on a systematic review of existing clinical practice guidelines, followed by application of the ADAPTE methodological process described by Guidelines International Network for adapting guidelines for cultural and professional utility. The recommendations contained in this guideline are derived from the 2021 Scottish Intercollegiate Guideline Network (SIGN) document: Management of Osteoporosis and the Prevention of Fragility Fractures . These guidelines are intended to assist physical therapists practicing in the United States, and implementation in the context of the US health care system is discussed.

Purpose: The Test of Incremental Respiratory Endurance (TIRE) provides a comprehensive assessment of inspiratory muscle performance by measuring maximal inspiratory pressure (MIP) over time. The integration of MIP over inspiratory duration (ID) provides the sustained maximal inspiratory pressure (SMIP). Evidence on the reliability and validity of these measurements in COPD is not currently available. Therefore, we assessed the reliability, responsiveness and construct validity of the TIRE measures of inspiratory muscle performance in subjects with COPD. Patients and methods: Test–retest reliability, known-groups and convergent validity assessments were implemented simultaneously in 81 male subjects with mild to very severe COPD. TIRE measures were obtained using the portable PrO2 device, following standard guidelines. Results: All TIRE measures were found to be highly reliable, with SMIP demonstrating the strongest test–retest reliability with a nearly perfect intraclass correlation coefficient (ICC) of 0.99, while MIP and ID clustered closely together behind SMIP with ICC values of about 0.97. Our findings also demonstrated known-groups validity of all TIRE measures, with SMIP and ID yielding larger effect sizes when compared to MIP in distinguishing between subjects of different COPD status. Finally, our analyses confirmed convergent validity for both SMIP and ID, but not MIP. Conclusion: The TIRE measures of MIP, SMIP and ID have excellent test–retest reliability and demonstrated known-groups validity in subjects with COPD. SMIP and ID also demonstrated evidence of moderate convergent validity and appear to be more stable measures in this patient population than the traditional MIP.

Clonus arising from plantar flexor hyperreflexia is a phenomenon that is commonly observed in persons with spastic hypertonia. We assessed the temporal components of a biomechanical measure to quantify ankle clonus, and validated these in persons with spasticity due to spinal cord injury. In 40 individuals with chronic (>1 year) spinal cord injury, we elicited ankle clonus using a standardized mechanical perturbation (drop test). We examined reliability and construct validity of 2 components of the drop test: clonus duration (timed with a stopwatch) and number of oscillations in the first 10-second interval (measured via optical motion capture). We compared these measures to the Spinal Cord Assessment Tool for Spastic reflexes (SCATS) clonus score and H-reflex/M-wave (H/M) ratio, a clinical and electrophysiologic measure, respectively. Intra- and interrater reliability of clonus duration measurement was good [intraclass correlation coefficient, ICC (2, 1) = 1.00]; test-retest reliability was good both at 1 hour [ICC (2, 2) = 0.99] and at 1 week [ICC (2, 2) = 0.99]. Clonus duration was moderately correlated with SCATS clonus score (r = 0.58). Number of oscillations had good within-session test-retest reliability [ICC (2, 1) > 0.90] and strong correlations with SCATS clonus score (r = 0.86) and soleus H/M ratio (r = 0.77). Clonus duration and number of oscillations as measured with a standardized test are reliable and valid measures of plantar flexor hyperreflexia that are accessible for clinical use. Tools for objective measurement of ankle clonus are valuable for assessing effectiveness of interventions directed at normalizing reflex activity associated with spasticity. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A179).

The Shoulder Pain and Disability Index (SPADI) is a tool designed to evaluate the impact of shoulder pathology. The aim of this study was to cross culturally adapt a Spanish version of the SPADI for Spanish population with a musculoskeletal shoulder pain, and to determine the psychometric properties of this instrument using confirmatory factor analysis (CFA). Cross-cultural adaptation was performed according to the international guidelines. To assess factor structure, a confirmatory factor analysis was done. Internal consistency was measured using Cronbach’s alpha. Item-total and inter-item correlations were assessed. Pearson and Spearman correlations were calculated to assess the convergent validity between SPADI and quick-DASH. A new Spanish version of SPADI was achieved. The original SPADI factor structure was tested by CFA, obtaining a poor fit: relative chi-square (χ2/df) 3.16, CFI 0.89, NFI 0.92, and RMSEA 0.10 (90 % CI 0.08 to 0.12). An additional model was tested, after deleting items which have had a poor adjustment in the model (1, 11, and 12), obtaining the best fit: relative chi-square (χ2/df) of 1.94, CFI 0.98, NFI 0.95, GFI 0,95, and RMSEA 0.06 (90 % CI 0.04 to 0.09). The analysis confirmed the bidimensional structure (pain and disability subscales). A correlation Spearman’s Rho coefficient of 0.752 (p < 0.0001) and a Cronbach’s alpha of 0.90 were obtained. This study validated a new 10-items version of SPADI for Spanish population with musculoskeletal shoulder pain providing a patient reported outcome measure that could be used in both clinical practice and research.

Background Based on changes in core physical therapy documents and problems with the earlier version, the Physical Therapist Clinical Performance Instrument (PT CPI): Version 1997 was revised to create the PT CPI: Version 2006. Objective The purpose of this study was to validate the PT CPI: Version 2006 for use with physical therapist students as a measure of clinical performance. Design This was a combined cross-sectional and prospective study. Methods A convenience sample of physical therapist students from the United States and Canada participated in this study. The PT CPI: Version 2006 was used to collect CPI item–level data from the clinical instructor about student performance at midterm and final evaluation periods in the clinical internship. Midterm evaluation data were collected from 196 students, and final evaluation data were collected from 171 students. The students who participated in the study had a mean age of 24.8 years (SD=2.3, range=21–41). Sixty-seven percent of the participants were from programs in the United States, and 33% were from Canada. Results The PT CPI: Version 2006 demonstrated good internal consistency, and factor analysis with varimax rotation produced a 3-factor solution explaining 94% of the variance. Construct validity was supported by differences in CPI item scores between students on early compared with final clinical experiences. Validity also was supported by significant score changes from midterm to final evaluations for students on both early and final internships and by fair to moderate correlations between prior clinical experience and remaining course work. Limitations This study did not examine rater reliability. Conclusion The results support the PT CPI: Version 2006 as a valid measure of physical therapist student clinical performance.