ABSTRACT Background and Purpose: Physical therapist (PT) consultation in the Emergency Department (ED) has evolved significantly over the past 25 years. This review serves to summarize the nature of these changes and the advancement of related literature. Methods: To provide a historical narrative of the evolution of ED PT practice, a detailed search of the peer reviewed literature was conducted and summarized. Results: Practice of physical therapy in international EDs sets the precent for development of programs in the United States and Canada. ED PT programs in the early to late 2000s were rare, and supportive literature was largely theoretical or descriptive. The 2010s brought a proliferation of programs and the emergence of evidence establishing the effectiveness of ED PT services. Contemporary research has established that these services not only improve patient outcomes but are cost-effective. Conclusion and Discussion: This article illustrates the growth and development of ED PT practice in the United States and Canada and describes the evolution of supportive literature. Practitioners with aspirations of developing ED PT programs in their respective facilities may incorporate these ideas into efforts to promote implementation of these services to hospital administrators and managers on the value of implementing these services.
ABSTRACT Background and Purpose: Physical therapists embedded within the emergency department (ED) are quickly becoming standard in the United States, with multiple benefits relating to improved patient outcomes and increased clinical efficiency. No studies have yet described the benefits of physical therapists clinical reasoning skills related to ordering and interpretation of diagnostic imaging in the ED. As the number of states allowing physical therapist–initiated imaging orders has grown, it is essential for ED physical therapists to appropriately leverage this tool for improved patient examination and care. The purpose of this case report is to review 3 unique cases in the ED where a physical therapist enhanced patient outcomes through imaging in various constructs (ordering, interpretation of existing images). Case Description: We describe 3 patients who presented to the ED of a large urban academic medical center with a dedicated ED physical therapy program. Each patient was evaluated by an emergency medicine clinician (physician, physician assistant, or nurse practitioner), who consulted the embedded ED physical therapist to assist in the evaluation and treatment of clinical conditions relevant to physical therapy practice: suspected musculoskeletal (MSK)-related pain, trauma-related pain status postfall, and dizziness/imbalance. Outcomes: Each individual case demonstrates the way imaging can affect ED physical therapist differential diagnosis and play a role in effective patient care management while enhancing patient outcomes through expediting necessary care and/or medical intervention. Examples include expanding suspected musculoskeletal pain differential to peripheral vascular disease, altering medical team regarding concern for hip fracture after initial negative radiographs, and obtaining stroke diagnosis via magnetic resonance imaging (MRI) for a patient presenting with assumed peripheral vertigo. Discussion and Conclusion: As the number of states allowing physical therapist–initiated imaging orders has grown, it is essential for ED physical therapists to appropriately leverage imaging as a diagnostic tool for improved patient examination and care. Development of benchmarks for ED physical therapy competency in imaging will also facilitate clearer delineation of ED physical therapy as future specialty consistent with international standing.
ABSTRACT Introduction: Patient care in inpatient settings is challenging for health care students and requires adaptive behavioral, cognitive, and technical skills that can be enhanced with simulation-based education (SBE). This study investigates how repeated SBE experiences created in line with the Academy of Acute Care Physical Therapy Core Competencies for Entry-Level Practice in Acute Care Physical Therapy (AACPT-CCACPT) during Doctor of Physical Therapy (DPT) coursework affect self-confidence with patient management. We hypothesized that student self-confidence in skill and readiness to practice would improve from the introduction of SBE to the end of a terminal clinical experience (CE-T). Methods: A convenience sample of DPT students in 2 cohorts (Class of 2024: n = 84; 2025: n = 83) was recruited during courses with progressively complex SBE to complete a confidence self-assessment survey 3 times. Using SPSS Statistics 29, a paired t -test was used to determine if a statistically significant increase in self-confidence for Class '25 occurred between pre and post SBE periods, and a one-way RM ANOVA for Class '24 and '25 within pre, post, and CE-T time points. Results: Paired t -test results for ('25) indicated a statistically significant mean increase in self-confidence at post-test compared with pretest when comparing pre and post SBE periods scores ( P < .001). One-way RM ANOVA results for '24 between pre, post, and CE-T ( P < .001) and Class '25 between pre, post, and CE-T ( P < .004) indicated a statistically significant mean increase in self-confidence and perception of readiness to practice. Conclusions: DPT students reported increased self-confidence after SBE and after CE-T. Progressively complex SBE may improve DPT student preparedness for inpatient practice.
ABSTRACT Purpose: Poststroke rehabilitation is critical for functional recovery, yet the impact of stroke location on therapy response remains underexplored. Cortical and subcortical strokes differ in motor learning mechanisms, raising questions about the role of therapy frequency and the use of error augmentation training in early recovery. This post hoc analysis builds on previously published pilot data ( JACPT , July 2024) and aims to explore whether frequent error augmentation therapy (twice-daily sessions) improves functional outcomes in subcortical strokes similarly to cortical strokes. Methods: This secondary analysis included 96 patients with acute stroke enrolled in the initial pilot study who received either twice-daily error augmentation (EA) training or standard-of-care therapy sessions 3-5 times per week during hospitalization. EA training amplifies implicit movement errors to enhance motor adaptation. Functional outcomes, including the Postural Assessment Scale for Stroke (PASS), Activity Measure for Post-Acute Care (AM-PAC), and modified Rankin Scale (mRS), were analyzed using longitudinal mixed models, stratified by stroke location (cortical and subcortical). Results: The EA intervention group demonstrated significantly greater functional improvements than controls across both stroke subgroups. In subcortical strokes, postural balance gains from hospitalization to 90-day follow-up (PASS Total: 9.4 points) were comparable with those in cortical strokes (12.1 points), both significantly surpassing control group improvements. Similarly, AM-PAC mobility scores improved by approximately 3 points in both subcortical and cortical treatment subgroups compared with their respective controls. Conclusions: This secondary, exploratory analysis suggests that both increased therapy frequency and EA training may contribute to functional gains in subcortical strokes, with trends similar to those previously observed in cortical strokes. Although these findings expand upon prior work, they should be interpreted cautiously given the post hoc nature of this analysis. Further research is needed to confirm whether frequent EA training provides consistent benefits across stroke subtypes and to clarify the mechanisms underlying these potential effects.
