Emilio J. Puentedura

Low back pain (LBP) is the most prevalent musculoskeletal disorder globally and a leading cause of disability. It imposes a major societal and economic burden by impairing quality of life and incre...

Although diverse pedagogical approaches are encouraged in physical therapy education, lectures remain the primary method for teaching modern pain science. The purpose of this study was to examine changes in knowledge, attitudes, beliefs, and clinical recommendations regarding chronic low back pain (CLBP) among entry-level Doctor of Physical Therapy (DPT) students after a pain neuroscience education (PNE) telehealth simulation. A mixed-methods QUAN-qual explanatory sequential design was used. One hundred fifteen students completed quantitative measures, and 32 participated in semi-structured focus groups. Pre- and post-simulation, students completed the Revised Neurophysiology of Pain Questionnaire (RNPQ), Healthcare Providers' Pain and Impairments Relationship Scale (HC-PAIRS), and a clinical vignette. The Simulation Effectiveness Tool-Modified (SET-M) was administered post-simulation. Results demonstrated small but significant improvements in RNPQ, HC-PAIRS, and vignette scores, although effect sizes were modest. Weak positive correlations were found between RNPQ and HC-PAIRS (r = .155) and vignette scores (r = .199). The median SET-M score was 54. Qualitative analysis identified four themes: (1) safe but realistic experience, (2) learning through discomfort, (3) validation of patient pain, and (4) value of metaphors and analogies. Findings support the integration of experiential methods, such as simulation, into pain science education.

Competency-based education (CBE) emphasizes mastery of defined competencies rather than time-based progression. Within orthopedic manual physical therapy (OMPT), the evolving evidence supports person-centered, evidence-informed care, requiring fellowship training standards that reflect this shift. Among the seven proposed domains of competence, Systems-Based Practice (SBP) and Patient Management (PM) are essential. SBP focuses on navigating healthcare systems, interprofessional collaboration, and advocacy, while PM emphasizes delivering comprehensive, value-based care through evidence-informed, person-centered approaches. Consensus on competencies for these domains in OMPT fellowship training remains unclear. To achieve an international consensus on competencies and graduation milestones for OMPT fellowship training in SBP and PM. A modified three-Round Delphi study was conducted. In Round I, nine content experts drafted competencies and milestones. Rounds II and III invited stakeholders from the International Federation of Manual and Musculoskeletal Physical Therapists (IFOMPT) member organizations via web-based surveys. Consensus was defined a priori as ≥ 80% agreement. Descriptive statistics and composite scores were used to assess the strength of agreement. The reporting in this study follows guidelines from the Accurate Consensus Reporting Document (ACCORD). Systems-Based Practice (SBP): Five competencies and 19 milestoneswere proposed; four competencies achieved consensus (health screening, healtheducation, healthcare system navigation, health policy and advocacy). PatientManagement (PM): Six competencies and 17 milestones achieved consensus,with the strongest support for evidence-informed treatment implementation,person-centered care, cultural and social sensitivity, and outcomeoptimization. Lesser support was observed for applying the human movementsystem framework. Findingsunderscore the importance of competencies that promote leadership, advocacy,and evidence-informed, person-centered care in OMPT fellowship training. Gapsin consensus regarding quality improvement and the application of movementsystems highlight areas for future study or development. These resultscontribute to a global framework for advanced OMPT fellowship-level education.

Gross anatomy is a foundational first‐year component of Doctor of Physical Therapy (DPT) curriculum, with limited future vertical integration. Retrieval practice and spaced learning to enhance retention are rarely embedded in second‐year DPT coursework. This study evaluated Integrated Anatomy Experiences (IAEs) in a musculoskeletal Patient Management Course (PMC). Sixty‐two second‐year DPT students participated in two IAEs incorporating: peer‐led osteology review, prosected donor exploration, faculty‐guided palpation and assessment, and integrated clinical application. A mixed‐methods design guided by Kirkpatrick Levels 1 and 2 was used. Knowledge was assessed pre/posttest using identical multiple‐choice questions. Item‐level performance was analyzed using Wilcoxon signed‐rank tests, effect sizes, and item difficulty. Student perceptions of the IAEs were collected through de‐identified reflections and analyzed thematically using a structured codebook. Nine of 10 items demonstrated higher proportions of correct answers on the posttest, with significant improvement for most items ( p < 0.05). Effect sizes were medium to large ( r = 0.31–0.63). Item‐difficulty indices increased for most items, and distractor analysis revealed reductions in implausible choices. Qualitative analysis showed predominantly positive reactions; students emphasized improved understanding of anatomical relationships, greater appreciation of clinical relevance, enhanced spatial reasoning, and increased confidence with palpation skills. Only one student expressed discomfort in the donor laboratory. Embedding IAEs within second‐year PMCs appears to strengthen knowledge retrieval and promotes vertical integration of anatomy with clinical skills. This approach may be valuable for cohorts with limited prior hands‐on anatomy experience and is feasible when faculty collaborate to design multimodal learning activities.

Objective: To determine factors associated with neck pain in computer workers, focusing on working from home and body postures. Methods: Workers aged 18-65 who spent ≥75% of working hours on a computer were surveyed online annually over 3 years. Multinomial logistic regression analysed relationships between pain (neck pain, other musculoskeletal pain, no pain), work location (work vs home), and body posture accounting for factors typically associated with pain. Results: Of 1777 respondents, most (94%, n=1664) worked some time at home. Sitting posture (‘trunk a little bent forward’; OR 2.07; 95% CI 1.48-2.89), working from home (3.32; 2.43-4.52), being female (5.49; 3.99-7.56) and sleep quality (4.08; 2.32-7.18) were associated with neck pain (p<.001), and other pain (p<.001). Conclusion: These findings underscore the need for ergonomic guidelines and interventions that address posture in home and office environments. Export

Introduction Dry needling is increasingly used by physical therapists to manage pain and neuromusculoskeletal dysfunction. Despite widespread clinical adoption and regulatory support across most United States (US), dry needling instruction in entry-level Doctor of Physical Therapy (DPT) programs remains inconsistent. This study examined dry needling instruction in entry-level DPT programs by analyzing curricular structure, teaching philosophies, and student outcomes. Methods This descriptive, exploratory study used a mixed-methods design involving 338 students from 14 DPT programs across six US regions. Pre- and post-laboratory surveys assessed changes in student perceptions of dry needling safety, comfort, and self-efficacy using Wilcoxon signed-rank tests and Spearman’s correlations. Faculty interviews and open-ended student responses were thematically analyzed to explore instructional strategies and teaching philosophies. Results Dry needling instruction varied widely, with required hours ranging from 1.5 to 32 and initial exposure occurring between trimesters 1 and 7. Student-to-faculty ratios in labs ranged from 1:4 to 1:28. Of 1173 needle insertions, 66% targeted lower-extremity muscles. Student participation was high (94%), though needle fear (58%) was the main barrier. Laboratory experiences significantly improved perceptions of dry needling safety (p = 0.006) and self-efficacy (p = 0.003). Discussion Despite curricular inconsistencies, faculty shared five core teaching philosophies: prioritizing foundational exposure over clinical competency, emphasizing safety, using evidence-informed content, promoting hands-on skill development, and professional advocacy. Conclusions Findings highlight the need for standardized dry needling education guidelines in DPT programs. Establishing minimum competencies, recommended instructional hours, and safety protocols may enhance consistency and effectiveness in dry needling instruction.

Dry needling (DN) is a skilled intervention commonly used for pain relief and the management of movement disorders in neuromusculoskeletal conditions. Although systematic reviews indicate its effectiveness, variations in treatment parameters exist. This study surveyed U.S. healthcare professionals who utilize DN, examining their clinical techniques, rationale, and use of electrostimulation. An electronic survey was created and distributed via Qualtrics™ to healthcare providers performing DN. The survey link was shared through social media and e-mail, and data were analyzed using non-parametric statistical methods (Mann-Whitney U, Spearman's rho) to identify significant patterns in DN practices. A total of 1,399 healthcare providers completed the survey, predominantly physical therapists (93.3%) with an average of 13.5 years of clinical experience and 5.2 years in DN. Most worked in outpatient orthopedics (90.3%). Common DN techniques included trigger point needling (95.8%) and deep needling (82.0%), with 44.5% using periosteal pecking. The majority of practitioners used up to 4 needles per session (68.1%), while 63.8% used more than 4. Electro-stimulation (e-stim) was commonly applied, with 62.5% using it after needle insertion and 55.6% combining it with needle manipulation. Differences in techniques were noted between physical and nonphysical therapists, particularly in the practice of leaving needles in place without manipulation. This study highlights the widespread use and evolving methodologies of DN practices in the U.S. noting the integration of electrostimulation and multimodal approaches. It also highlights inconsistencies in treatment parameters, underscoring the need for standardized protocols to enhance clinical effectiveness and research validity. Future research should focus on the long-term efficacy of various DN techniques and their applications in neurological rehabilitation.

Introduction.: Despite the growing clinical use of dry needling (DN) among physical therapists in the United States and its gradual adoption into entry-level Doctor of Physical Therapy (DPT) programs, limited research exists on DN safety within educational settings. This study aims to report the type and incidence of adverse events (AEs) associated with DN instruction in DPT programs. Review of Literature.: To date, there has been no reporting on DN-related AEs during DPT education, making the relative risk of DN education unclear. Subjects.: Three hundred thirty-eight students and 10 faculty members from 10 US DPT programs. Methods.: Questionnaires and structured interviews investigated the type and incidence of AEs during DN instruction in DPT programs. Students documented prelaboratory comfort levels with DN and AEs experienced by their partners during laboratory practice. Postlaboratory interviews with DPT faculty gathered insights into AEs during instruction. Statistical methods included descriptive frequencies of AEs and reported pain. The AEs were classified as side effects, minor, moderate, or major, and were reported as percentages of total needle insertions and by body region. Results.: Among 338 DPT students (mean age = 26.3 years), no major or moderate AEs were recorded over 1,173 needle insertions and 16 muscle areas. The most reported side effects were soreness (48%) and pain (37%). Pain was self-reported by 50% of students, with the majority experiencing low levels (0–3/10) on the numerical pain rating scale. Lower prelaboratory comfort levels were reported between those who experienced a minor AE and those who did not ( P = .030). Side effects and minor AEs in DPT education appeared to closely resemble those in clinical settings. Discussion and Conclusion.: Student safety performing DN was high, with no major AEs reported. Faculty self-selection of muscle areas may have influenced major AE reporting. Findings suggest that DN can be safely included within DPT education, with risks similar to those in clinical practice.