Dawn M. Magnusson

Background: Although Ecuador’s Ministry of Public Health promotes regular physical activity, program design and implementation remains limited, especially in rural Indigenous communities. The purpose of this study was to examine Movimiento como Medicina (MCM) as a contextually grounded implementation strategy to enhance movement and physical activity counseling among health professionals serving Indigenous communities. Methods: An exploratory mixed methods design was used to assess core implementation outcomes: acceptability, appropriateness, and feasibility. Pre-post changes in provider confidence served as a proximal indicator of adoption. Differences in confidence were analyzed using a two-tailed Wilcoxon Signed-Rank Test for paired, non-parametric data. Qualitative data, collected via text responses to open-ended survey questions and analyzed via deductive thematic content analysis, helped further elucidate participants’ assessment of the program. Results: Thirty-six health professionals completed the one- or two-day MCM workshop. The mean acceptability score was 4.8 (Standard Deviation [SD] = 0.69). Ninety percent or more of participants strongly agreed that the training objectives were clearly stated, the facilitators were knowledgeable about the topics and created an engaging learning environment, and the pace of the training was appropriate. The mean appropriateness score was = 4.8 (SD = 0.68). Ninety-three percent of participants strongly agreed that the content was relevant to their work and that the program increased their understanding of movement as medicine. Seventy-seven percent of participants strongly agreed that the training included culturally appropriate examples. The most useful aspects of the training included talking through and applying content to learning cases and practicing the various movement-based strategies. The mean feasibility score was 4.65 (SD = 0.61). 92% of participants were likely or very likely to integrate movement strategies into their practice as a result of the workshop. Participants’ confidence in identifying the four components of movement, discussing the benefits of movement, and exploring community beliefs regarding movement increased significantly from pre- to post-training. Conclusion: MCM’s high acceptability, appropriateness, and feasibility, combined with significant improvements in participant confidence, positions the program as a contextually aligned and scalable health promotion strategy.

Importance: Implementing evidence-based dosing of rehabilitation in skilled nursing facilities (SNFs) is essential to improve functional outcomes in a medically complex population. Objective: The objective was to evaluate an implementation program promoting high-intensity resistance rehabilitation (HIR) in SNFs by (1) measuring proximal (clinician knowledge, self-efficacy, and HIR perspective) and distal (HIR adoption and implementation) outcomes; (2) exploring how the program influenced distal outcomes (program processes); and (3) investigating clinician factors influencing HIR implementation. Design: The design was a prospective convergent mixed-methods, theory-driven program evaluation. Setting: This study was conducted across 8 rural Department of Veterans Affairs SNFs. Participants: Rehabilitation clinicians (n = 38) and leaders (n = 16) were included. Interventions or Exposures: All sites received a multicomponent implementation program promoting HIR. Main Outcomes and Measures: Validated questionnaires assessed HIR perspective (Perceived Characteristics of Intervention Scale) and adoption (Commitment to Change Scale). Study-specific questionnaires measured clinician HIR knowledge, self-efficacy, and implementation. Interviews and focus groups explored program processes and clinician factors. Results: The program improved clinician HIR knowledge, self-efficacy, and perspective, leading to acceptable adoption rates. Implementation was marginally affected. Only the clinician perspective correlated with adoption (P = .47). Qualitatively, the program supported distal outcomes by keeping HIR at the forefront of clinicians’ mind, fostering positive outcome expectations, and enhancing team cohesion and accountability. Clinician creativity, adaptability, resilience, professional discipline, and previous experience influenced implementation. Conclusion: The program influenced HIR adoption primarily by enhancing clinicians’ positive perspectives of HIR. Future efforts could strengthen implementation by fostering team cohesion, accountability, and clinician creativity while also assessing environmental factors. Relevance: Effective HIR implementation can optimize patient outcomes. Strategies that enhance clinician perspective and creativity, keep HIR at the forefront, and foster team cohesion and accountability may improve adoption. Additionally, assessing and addressing environmental factors may further support sustainable integration of HIR into clinical practice.

Background: Muscle health is an emerging concept linked to physical performance and functional independence. However, the term lacks a standardized definition and is often used as a broad muscle-related outcome descriptor. Clinical communication and research would benefit from a conceptual model of muscle health grounded in an established framework. Methods: We conducted systematic search and narrative synthesis to identify multifactorial measurement approaches explicitly described under ‘muscle health’. PubMed and CINAHL were searched for clinical and randomized controlled trials published in the past 5 years (final search: March 2025) that used the term “muscle health.” Studies were reviewed for explicit definitions of “muscle health,” and all identified outcomes (e.g., strength, mass) and measurement tools (e.g., grip strength, ultrasound) were synthesized. This review was retrospectively registered (INPLASY202580069). Results: Of the 65 clinical or randomized controlled trials that met inclusion criteria, 29 provided an operational definition of ‘muscle health’, while 36 inferred measurements without a clear definition. The identified measurements spanned four primary categories, with body composition/muscle mass being the most common (92.3%), followed by muscle performance (78.5%), physical function (63.1%), and tissue composition (30.8%). Most studies included more than one muscle health metric (93.9%). Common assessment methods included DXA (44.6%), grip strength (64.6%), and gait speed (27.7%). Conclusions: While there are common measurement approaches, the definition of muscle health varies widely in the cited works. The framework of the International Classification of Functioning, Disability and Health, was used to identify domains aligned with muscle health components of muscle morphology/morphometry (e.g., mass and composition), functional status (performance-based tasks), and physical capacity (muscle performance). This framework provides a structured basis for evaluating muscle health in research and clinical practice. Consistent use of these domains could enhance assessment and support efforts to standardize testing and interpretation across settings.

Background: Muscle health is an emerging concept, increasingly cited in studies associated with physical performance and functional independence. However, the term lacks a clear operational or conceptual definition and often serves as a general descriptor of any muscle-related outcome. Clinical communication and research designs would benefit from a sound conceptual model of muscle health grounded in an established framework concerning physical health and muscle function. Methods: Thus, our proposed model is informed by a systematic literature review and synthesis regarding the multi-factorial measurement approaches used to characterize skeletal muscle. Three investigators screened 333 papers with search criteria for clinical and randomized controlled trials and "muscle health". Results: Of the 68 papers that met inclusion criteria, 31 studies provided an operational definition of "muscle health", while 37 inferred measurements without a clear definition. The identified measurements spanned four primary categories, with body composition/muscle mass being the most common (92.7%), followed by muscle performance (76.5%), physical function (61.8%), and tissue composition (30.9%). Most studies included more than one muscle health metric (94.1%). Common assessment methods included DXA (41.2%), grip strength (63.2%), and gait speed (26.5%). Conclusions: Using the framework of the International Classification of Functioning, Disability and Health, measurement categories identified aligned with muscle health components of muscle morphology/morphometry (e.g., muscle mass and composition), functional status (performance-based tasks), and physical capacity (objective maximal or submaximal measures of muscle performance). Consistently applying these measurement domains could aid the assessment of muscle health and facilitate further work to standardize specific approaches to testing and data interpretation across settings.

The 2001 National Academy of Medicine (previously the Institute of Medicine) report Crossing the Quality Chasm: A New Health System for the 21^st Century listed health equity as one of 6 pillars in delivering high-quality health care. ¹ In 2003, the Academy published Unequal Treatment, detailing how health disparities arise in health care and what systems can do to reduce disparities through financing, service innovation, language accessibility, training in cultural humility, and community-centered partnerships. ² The pervasive disparities and unrelenting social injustices outlined in these reports persist 20 years later, and, in many cases, have worsened in the wake of the COVID-19 pandemic. Health disparities are defined as systematic and avoidable differences in health that adversely affect groups that have been historically marginalized (characteristics include race, ethnicity, nationality, socioeconomic status [income, wealth, education, or occupation], sex, gender identity, sexual orientation, and disability). ³ In alignment with the National Academy of Medicine reports cited above, the American Physical Therapy Association calls upon its members to “recognize health disparities and work to ameliorate them” through advocacy, community-engaged practice, service innovation, and attention to social and structural drivers of health. ⁴ Where our work becomes challenging is in translating what we know about the nature of health disparities into meaningful and actionable change.

The 2001 National Academy of Medicine (previously the Institute of Medicine) report Crossing the Quality Chasm: A New Health System for the 21^st Century listed health equity as one of 6 pillars in delivering high-quality health care. ¹ In 2003, the Academy published Unequal Treatment, detailing how health disparities arise in health care and what systems can do to reduce disparities through financing, service innovation, language accessibility, training in cultural humility, and community-centered partnerships. ² The pervasive disparities and unrelenting social injustices outlined in these reports persist 20 years later, and, in many cases, have worsened in the wake of the COVID-19 pandemic. Health disparities are defined as systematic and avoidable differences in health that adversely affect groups that have been historically marginalized (characteristics include race, ethnicity, nationality, socioeconomic status [income, wealth, education, or occupation], sex, gender identity, sexual orientation, and disability). ³ In alignment with the National Academy of Medicine reports cited above, the American Physical Therapy Association calls upon its members to “recognize health disparities and work to ameliorate them” through advocacy, community-engaged practice, service innovation, and attention to social and structural drivers of health. ⁴ Where our work becomes challenging is in translating what we know about the nature of health disparities into meaningful and actionable change.

Background and Purpose.: Entry-level physical therapist (PT) education programs play a critical role in inspiring future leaders to become moral change agents, capable of understanding and addressing evolving societal health needs. Social reconstructionism represents an educational philosophy focused on alleviating pervasive inequities and improving the health of society; however, its application in PT education is not well understood. The purpose of this article is to describe the approach 3 entry-level PT programs used to manifest social reconstructionism within their curricula to foster social consciousness and strengthen moral agency. Method/Model Description and Evaluation.: The Framework for Educating Health Professionals to Address the Social Determinants of Health informed the development of a conceptual framework that illustrates the role of PT education programs in creating transformative learning environments and preparing learners to meet societal health needs. Concepts within this framework were operationalized according to 5 domains put forth by Jensen et al. and related competencies put forth by the Association of American Medical Colleges. Outcomes.: Narratives from each program demonstrate how the design and implementation of curricula, grounded in social reconstructionism, can be accomplished through 1) ongoing modifications, 2) thoughtful reconstruction, and 3) initial design. Sample learning activities, objectives, and assessment strategies are provided. Discussion and Conclusion.: The proposed method was effective in guiding meaningful objectives, learning activities, and assessment strategies grounded in social reconstructionism. Such findings can inform the design of curricula that inspire the next generation of transformative leaders who work to alleviate pervasive inequities and improve the health of society.

Background: After lower limb amputation, several prosthesis design options exist. However, prosthesis design decisions do not always reflect a prosthesis user’s needs, values, and preferences. Objective: To develop a patient decision aid (PDA) prototype for prosthetists and new prosthesis users facing prosthesis design decisions after lower limb amputation, and to assess its usability, accuracy, and comprehensibility. Study design: Exploratory mixed methods. Methods: PDA development was informed by a qualitative needs assessment and guided by the International Patient Decision Aid Standards. The PDA was evaluated by steering groups of experienced prosthesis users and prosthetic professionals (prosthetists and researchers) to test usability, accuracy, and comprehensibility through focus groups, individual interviews, and rating on a Likert scale ranging from 1 to 10. Results: The resulting PDA included 6 sections: (1) Amputation and Early Recovery, (2) Communication, (3) Values, (4) Prosthesis Design, (5) Preferences, and (6) Prosthetic Journey. Usability, accuracy, and comprehensibility were rated as 9.2, 9.6, and 9.6, respectively, by prosthetic professionals, and 9.4, 9.6, and 9.6, respectively, by prosthesis users. Discussion: The PDA incorporated guidance by relevant stakeholders and was rated favorably, emphasizing a need for shared decision-making support in prosthesis design. One challenge was determining the amount of information in the PDA, highlighting the diversity in end users’ informational needs. Future iterations of the PDA should undergo beta testing in clinical settings. Conclusions: A standardized, iterative method was used to develop a PDA for new lower limb prosthesis users and prosthetists when considering prosthesis design decisions. The PDA was considered useable, accurate, and comprehensible.

Objectives (1) Explore the relationship between various sociodemographic factors and caregiver health beliefs (CHBs), and (2) examine whether these relationships were associated with the use of pediatric therapy services. Methods We conducted a cross-sectional, secondary data analysis using the 2011 Survey of Pathways Diagnosis and Services dataset. 4,032 children ages 6–17 years had complete data on caregiver health beliefs and pediatric therapy use. Select CHBs reflected whether caregivers believe (1) problems related to their child’s condition can be prevented or decreased with treatment, (2) they have the power to change their child’s condition, and (3) their child’s condition is a mystery. Pediatric therapy included physical therapy, occupational therapy, and speech therapy. We performed multivariate logistic regression to test the associations between CHBs and select child and family characteristics (Aim 1) and use of pediatric therapy services (Aim 2). Results Caregivers with lower educational attainment were more likely to believe their child’s condition was a mystery and less likely to believe they had the power to change their child’s condition. Use of pediatric therapy services tended to be lower among children whose caregivers believed they had the power to change their child’s condition and higher among children whose caregivers believed their child’s condition was a mystery. Conclusions for practice Our findings add to existing research that suggests CHBs differ across groups of caregivers. This, combined with the recognition that CHBs also likely differ from providers, underscores the importance of eliciting caregiver beliefs, values, and priorities to help ensure the provision of truly family-centered care. Significance Pediatric therapy services support and optimize child development. Significant service use disparities exist, however, with children representing various marginalized groups being less likely to use pediatric therapy services. Little is known about the mechanisms underlying such disparities. We sought to explore the relationship between family sociodemographic factors, caregiver health beliefs, and pediatric therapy use. Our findings suggest that caregivers with fewer socioeconomic resources expressed beliefs that are consistent with limited knowledge and agency regarding their child’s condition. Thus, providers must work to engage families in conversations about their child’s development, elicit their knowledge and beliefs, and identify social or financial barriers to care.

Background: Prosthesis design is complex and multiple appropriate options exist for any individual with lower-limb amputation. However, there is insufficient evidence for guiding decision-making. Shared decision-making (SDM) offers an opportunity to incorporate patient-specific values and preferences where evidence is lacking for prosthesis design decisions. To develop resources to facilitate SDM, and consistent with the International Patient Decision Aid Standards, it is necessary to identify the decisional needs of prosthetists and prosthesis users for prosthesis design decisions. Objectives: To assess the needs of prosthetists and new prosthesis users for SDM about the first prosthesis design. Study design: Qualitative descriptive design. Methods: Six focus groups were conducted with 38 prosthetists. Individual semistructured interviews were conducted with 17 new prosthesis users. Transcripts were analyzed using directed content analysis, with codes defined a priori using existing frameworks for SDM: the Three Talk Model for SDM and the Ottawa Decision Support Framework. Results: Four main themes were identified among prosthetists and prosthesis users: acknowledging complexity in communication, clarifying values, recognizing the role of experience to inform preferences, and understanding the prosthetic journey. Conclusions: Resources that support SDM for the first prosthesis design should consider methods for identifying individual communication needs, support with clarifying values, and resources such as experience for achieving informed preferences, within the context of the overall course of rehabilitation and recovery following lower-limb amputation. The themes identified in this work can inform SDM to promote collaborative discussion between prosthetists and new prosthesis users when making prosthesis design decisions.