INTRODUCTION:Clinical education is essential for student physical therapists (SPTs), but supervising students may affect physical therapist clinical instructors' (PT CIs) stress and burnout levels, potentially influencing their decision to accept students. This study examined factors that influence PT CIs' decisions to accept SPTs for clinical education experiences and explored how these factors affect PT CIs' perceptions of stress and burnout. REVIEW OF LITERATURE:Physical therapist CIs have been found to experience moderate levels of burnout. SUBJECTS:Twenty-one PT CIs were experiencing varying levels of burnout. METHODS:Utilizing a phenomenological approach, participants were interviewed using a semi-structured guide. Participants were chosen from a prior survey study that assessed stress and burnout levels. The interviews were recorded, transcribed verbatim, and analyzed for themes using NVivo software. RESULTS:Six thematic constructs emerged: (1) Experiencing renewal and purpose: How mentoring students reinvigorates clinical instructors' professional identity, (2) Weighing capacity against commitment: Decision making about student supervision through the lens of professional exhaustion, (3) Navigating the dual demands: The lived experience of balancing teaching responsibilities with clinical pressures, (4) Transforming the supervisory burden: How student interactions reshape clinical instructors' experience of workplace stress, (5) Gauging readiness and risk: Clinical instructors' assessment of student preparedness as a pathway to mentorship decisions, and (6) Carrying forward the difficult past: How previous challenging student encounters shape future mentorship boundaries and approaches. DISCUSSION AND CONCLUSION:PT CIs consider various factors when deciding to accept an SPT, including personal stress and burnout levels, SPT characteristics, and their past experiences with students. Although clinical education can increase workload and stress, particularly with early-rotation or challenging students, PT CIs generally view the experience as beneficial for their professional development and the field. Understanding these factors may help academic programs better support clinical sites and enhance students' and instructors' clinical education experience.

IMPORTANCE:Pediatric constraint-induced movement therapy (PCIMT) is increasing as a treatment method for children with unilateral hemiparesis, but limited evidence has been published on the outcomes of clinic-based PCIMT programs. OBJECTIVE:To evaluate the outcomes of a clinic-based PCIMT program on upper extremity movement quality of children with unilateral hemiparesis. DESIGN:Quantitative, retrospective study. SETTING:A children's hospital in the southern United States. PARTICIPANTS:Twenty-six children ages 2.5 to 8 yr with unilateral hemiparesis who previously completed a 3-wk PCIMT program were enrolled. INTERVENTION:A clinic-based PCIMT program from the ACQUIREc therapy protocol was used. Treatment included a 3-wk PCIMT program, consisting of 2 wk of unimanual activities followed by 1 wk of bimanual activities 4 days a week, 4 hr a day. OUTCOMES AND MEASURES:Upper extremity movement quality was assessed with the Melbourne Assessment of Unilateral Upper Limb Function-2 based on pre- and postintervention scores documented in participants' clinical records. Participants were categorized by their Manual Abilities Classification Scale (MACS) or Mini-MACS level. RESULTS:Significant improvements were observed in range of motion, accuracy, dexterity, and fluency of movement postintervention. MACS and Mini-MACS levels were significant predictors of accuracy improvement but not of other movement quality measures. CONCLUSIONS AND RELEVANCE:Findings suggest that clinic-based PCIMT programs can significantly improve upper extremity movement quality for children with unilateral hemiparesis. These findings support the clinical application of PCIMT and highlight the need for further research to optimize treatment protocols and predict outcomes based on classification levels. Plain-Language Summary: This study evaluated the outcomes of a clinic-based pediatric constraint-induced movement therapy (PCIMT) program for children with unilateral hemiparesis. The results showed significant improvements in the children's upper extremity movement quality, including range of motion, accuracy, dexterity, and fluency. The findings suggest that clinic-based PCIMT can be an effective treatment for improving movement quality of children with unilateral hemiparesis. They findings also suggest the need for further research to evaluate these programs and determine whether predictive outcomes can be based on individual characteristics.

IMPORTANCE:Availability of rehabilitation providers is a critical component of access to care, yet little is known about how workforce supply relates to community demographic characteristics within urban and rural regions. OBJECTIVE:The objective of this study was to examine geographic variability in the availability of licensed physical and occupational therapy providers in Texas and evaluate the relationship between provider supply and community-level characteristics including race and ethnicity, disability, and poverty. DESIGN:The study used a descriptive, cross-sectional observational study design. SETTING:The setting was all 6896 census tracts across the state of Texas. PARTICIPANTS:Participants included all physical therapists, physical therapy assistants, occupational therapists, and occupational therapy assistants who held a license in 2022 and resided in Texas. INTERVENTIONS/EXPOSURES:Provider workforce supply was derived from state licensure records and linked to population-level demographic and socioeconomic data from the American Community Survey using geospatial analysis. MAIN OUTCOMES AND MEASURES:The population-to-provider ratio for physical therapy and occupational therapy providers per census tract and its relationship to community demographics was the main outcome measure. RESULTS:Among 45,114 licensed physical therapy and occupational therapy providers, provider availability varied widely across Texas census tracts, with population-to-provider ratios ranging from 4 to 11,147 individuals per provider. Bivariate mapping showed that census tracts with fewer providers often overlapped with areas of higher disability prevalence, larger proportions of Hispanic or non-White residents, and higher poverty rates, particularly along southern and border regions and within parts of urban centers like southern Dallas and eastern Houston. Statistical comparisons revealed significant differences in racial composition between areas with the highest and lowest provider availability (χ26 = 1,561,831; Cramér V = 0.36) and in ethnic composition (χ2₁ = 1,012,990; Cramér V = 0.29). Differences in poverty (χ2₁ = 38,746; Cramér V = 0.06) and disability prevalence (χ2₁ = 5175.9; Cramér V = 0.02) were also significant but had smaller effect sizes. CONCLUSIONS:Substantial geographic variability exists in rehabilitation provider supply across census tracts in Texas, with lower availability in areas where populations may have higher needs. These findings highlight opportunities for workforce planning and targeted resource allocation to improve access to rehabilitation services in underserved regions. RELEVANCE:Understanding provider shortages at the census tract level combined with specific community demographics can inform workforce policy development, and initiatives to strengthen the rehabilitation workforce to meet population health needs. Addressing workforce diversity could improve access, patient-provider relationships, and culturally relevant care.

Equitable access to rehabilitation services is essential for individuals living with a disability, yet geographic disparities in outpatient rehabilitation care remain understudied. This study examined spatial accessibility to outpatient physical and occupational therapy services across Texas to identify regional inequities and inform workforce and policy planning. A descriptive cross-sectional geospatial analysis was conducted using outpatient clinic location data from the Texas Health and Human Services database (2022) and population data from the 2020 U.S. Census. Clinic addresses were verified and geocoded. Accessibility was measured using an origin-destination cost matrix to estimate the travel time to the nearest clinic, and the two-step floating catchment area (2SFCA) method to calculate an accessibility index. Spatial clustering of access was assessed using the Getis-Ord Gi* statistic to identify hot and cold spots. The analysis included 2255 outpatient rehabilitation clinics across 6896 census tracts. Travel times varied substantially, with rural areas experiencing the longest travel burdens. The 2SFCA analysis revealed pronounced disparities, with low-accessibility clusters concentrated in rural and border regions and high-accessibility clusters in urban metropolitan areas. These findings demonstrate persistent geographic disparities in outpatient rehabilitation access across Texas, suggesting the need for targeted workforce placement, transportation investment, and policy interventions to improve equitable access.

The primary purpose of this study was to evaluate the effectiveness of an Interprofessional education (IPE) experience using the Interprofessional Collaborative Competency Attainment survey (ICCAS). In total, 319 physical therapy and nursing students participated in a single IPE experience held annually over 3 years. All students were shown two patient care simulation videos highlighting two different styles of communication. Pre- and post‑activity, students anonymously completed the ICCAS. As a group, all 20 ICCAS items showed significant improvement with large effect sizes. The largest effect size was found for item 1: "Promote effective communication among members of an IP team." The largest domain improvement was found in communication. The secondary purpose of this study was to examine the relationship between change scores from ICCAS items #1 to #20 with ICCAS question #21. This study found that a single IPE experience using peer discussion and video was a highly effective and efficient way to enhance interdisciplinary communication and other IPE domains among nursing and physical therapy students. This IPE experience, which covers the IPE core competencies of values/ethics, roles/responsibilities, interprofessional communication, and teams/teamwork, should be considered by other programs looking for new and effective ways to incorporate IPE into their curriculum.

BACKGROUND:The mobility of the medial longitudinal arch contributes to foot function by accommodating to varying loads during dynamic weight-bearing activities. Physiologically, an external load, or stress, causes deformation in response to the application of load. Elasticity measures may offer insight into how load is distributed amongst synergistic muscles of the foot. The study's objective was to compare elasticity of extrinsic foot muscles across different categories of medial longitudinal arch mobility. METHODS:In this within- and between-subjects exploratory design, shear wave elastography was used to measure elasticity of the tibialis anterior, tibialis posterior, peroneal longus, and peroneal brevis in a non-weight-bearing and weight-bearing condition. Participants (N = 109) were classified into mobile, neutral, and rigid arch categories using the Arch Height Index Measurement System. FINDINGS:In non-weight-bearing, a significant interaction (p = 0.049) revealed elasticity of the tibialis posterior was significantly (p = 0.003, d = 0.90) greater in the rigid arch group when compared to the mobile arch group. In weight-bearing, a significant main effect (p = ≤0.001) for elasticity revealed all muscles, except the tibialis anterior and peroneal brevis comparison, were significantly (p = ≤0.001) different from one another (d = 0.75-3.09). INTERPRETATION:This study presents a new approach to clinical measures of muscle elasticity using shear wave elastography. The findings offer valuable insight into the mechanical properties of extrinsic foot muscle elasticity across medial longitudinal arch mobility categories and the potential load sharing between synergistic muscles. Results showed elasticity of the tibialis posterior differed between mobile and rigid arches. This information may help inform future research in biomechanics and rehabilitation.

Purpose: The purpose of this study was to explore child and caregiver (CG) satisfaction including their perceived benefits and barriers to modified ride-on car (MROC) use via a phenomenological qualitative research approach. Materials and methods: Six families received MROCs from a local GoBabyGo program and were instructed to use their MROC at least 1 h per week for 8 weeks. Following the study period, 4 child participants (3 years, 5 months to 4 years, 5 months) and 6 caregivers participated in semi-structured interviews about their lived experiences using MROCs. The data were analysed through open coding and content analysis qualitative approach. Results: Analysis revealed the overarching theme, satisfaction/"it's so cool!" The theme of benefits included subthemes of (1) "on his/her own," (2) "more freedom," (3) social/cognitive changes, with categories of peer engagement and "smiles the whole time," (4) individualisation of the MROC, and (5) other likes by adults. The theme of barriers included subthemes of (1) equipment issues, (2) driving on uneven terrain, and (3) need for adult supervision/assistance. Conclusion: This study provided details of the value of MROCs from the child's and caregiver's perspectives, which helps clinicians understand satisfaction and the physical and social/cognitive benefits and barriers of MROC use that are most important to young children with mobility challenges and their caregivers.

INTRODUCTION:Elasticity is a biomechanical property of muscle necessary for physical function and can be measured with shear wave elastography (SWE). SWE may be useful in diagnosing pathology, predicting injury, and monitoring rehabilitation. This would be beneficial for smaller muscles working synergistically to resist external loads during functional activities. Establishing clinical measures of elasticity in larger sample sizes is necessary prior to its use in assessing pathology and guiding intervention. PURPOSE:The study's primary aim was to investigate differences in elasticity for the tibialis anterior (TA), tibialis posterior (TP), peroneal longus (PL), and peroneal brevis (PB) muscles. It was hypothesized that there would be a statistically-significant difference in muscle elasticity both within and between non-weight-bearing (NWB) and weight-bearing (WB) positions. METHODS:Same-day, repeated-measures, cross-sectional design incorporating 109 healthy, recreationally active adults. Elasticity (kPa) was measured in NWB and 90 % WB. RESULTS:There was a statistically-significant interaction between muscle (TA, TP, PL, PB) and position (NWB, WB). Utilizing pairwise simple effects with Bonferroni correction, there was a significant (p ≤ 0.001-0.007) difference within muscles for NWB measures. WB measures revealed a significant (p ≤ 0.001) difference within muscles, except the TA-PB (p = 1.000). A significant (p ≤ 0.001-0.018) difference was found between NWB and WB positions for the TA, TP, and PB but not the PL (p = 0.140). CONCLUSION:The utility of SWE may help describe how the biomechanical property of elasticity differs between resting positions and functional states of muscle contraction. These findings may aid future clinical applications of SWE for injury prevention, rehabilitation, and physical performance.

BackgroundAccess to rehabilitation services is a critical yet under-studied dimension of health equity. Among the 6 domains of access, health care provider availability, defined as the presence of sufficient health care providers to meet population needs, is particularly underexplored in rehabilitation professions such as physical and occupational therapy. Current data reporting often lacks the geographic granularity required for effective workforce planning. ObjectiveThe purpose of this study was to demonstrate the feasibility of mapping rehabilitation provider availability at the census tract level using geographic information systems and integrating public licensure and population data to inform equitable workforce planning. MethodsA descriptive, cross-sectional study was conducted using publicly available state licensure data for physical and occupational therapists and demographic data from the American Community Survey. Residential addresses of rehabilitation providers were geocoded and matched to 2020 census tracts. Population-to-provider ratios were calculated and mapped using choropleth and bivariate mapping techniques. Population-to-provider ratios were calculated per tract and summarized overall and by rurality using 2020 Rural-Urban Commuting Area (RUCA) codes (urban: RUCA of 1-3; rural: RUCA of ≥4). The spatial dependence of ratios was tested using a spatial autocorrelation statistic, the global Moran I, in ArcGIS Pro using edge contiguity neighbors and row standardization. ResultsAcross 6896 tracts, ratios ranged from 4.5 to 11,147 persons per provider (median 1131, IQR 537-2501). By rurality, urban tracts (n=5734, 83.1%) had a median ratio of 1141 (IQR 2054), and rural tracts (n=1162, 16.9%) had a median ratio of 1093 (IQR 1690), indicating a broadly similar central tendency with somewhat greater variability in urban areas. The population-to-provider ratio exhibited significant positive spatial autocorrelation (global Moran I=0.305; Z=40.28; P<.001), consistent with clustered pockets of high and low availability rather than random dispersion. ConclusionsA replicable geographic information system protocol can integrate licensure and demographic data to produce interpretable population-to-provider metrics and spatial diagnostics at the census-tract level. In Texas, rehabilitation workforce availability is spatially clustered and not explained solely by an urban-rural divide, underscoring the value of small-area mapping for equitable workforce planning and policy decisions.

BACKGROUND:Older adults in care settings may use power mobility devices (PMDs) to facilitate independent mobility and engage in occupations. The relationship between previous PMD driving experience and cognitive impairment is not well understood. PURPOSE:This study examined how cognitive status and previous PMD experience affect the ability to operate PMDs safely and independently. METHOD:A total of 33 participants completed the Power-mobility Indoor Driving Assessment (PIDA) and Saint Louis University Mental Status Examination (SLUMS). Correlational statistics were used to analyse the data. FINDINGS:A Spearman's rho correlation coefficient for the cognitive impairment group (n = 29) revealed a weak, yet significant, positive correlation between the PIDA score and the SLUMS score (rs = .40, p = .03). Among those with cognitive impairment, persons with more previous PMD experience (n = 14) demonstrated significantly better PIDA overall scores, t(21.96) = -2.25, p = .035. There was a significant relationship between previous PMD experience and driving ability (rs = .429, p = .02). CONCLUSION:Results support the need to continue to provide intervention and support tailored for individuals with cognitive impairment to use a PMD safely in facilities. Clinicians should consider cognitive impairment and previous PMD experience when evaluating PMD users.

This feasibility study aimed to examine the change in trunk control as assessed by the Segmental Assessment of Trunk Control (SATCo), and activities of daily living, mobility, and social/cognitive skills as assessed by the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in young children with disabilities following MROC use. Eight participants received MROCs through a local GoBabyGo program and were instructed to use the MROC at least 1 hour per week for 8 weeks. Two participants did not complete the study. The remaining 6 participants (3 years, 0 months to 4 years, 5 months) were evaluated using the SATCo and PEDI-CAT 4 weeks before receiving their MROC, upon receiving the MROC, and after 4 and 8 weeks of MROC use. This study found improvement in SATCo level for 3 participants and no change or slight decrease in PEDI-CAT scores for all participants. No adverse events occurred. While improvement was found for the SATCo only in 3 out of the 6 participants, anecdotal reports of functional improvement and enjoyment from participant families indicate that further research is needed to holistically explore trunk control and the functional impact of MROC use in a naturalistic setting.

INTRODUCTION:This study investigates the prevalence of stress and burnout among Physical Therapy Clinical Instructors (PT CIs) using the Perceived Stress Scale - 10 (PSS-10) and Oldenburg Burnout Inventory (OLBI) surveys. Given the critical role of PT CIs in student education, understanding their stress and burnout levels is essential. REVIEW OF LITERATURE:The, PSS-10, a 10-item self-report survey, measures perceived stress with scores ranging from 0 to 40. It has demonstrated good psychometric properties, including test-retest reliability ( r = 0.77) and criterion validity ( r = -0.70 with short form-36). The OLBI, a 16-item survey, assesses burnout through disengagement and exhaustion subscales, showing strong reliability ( r = 0.85) and validity. SUBJECTS:The study included 494 PT CIs who met the inclusion criteria of having supervised a student physical therapist within the past 12 months and working full time. Participants were nationally recruited via emails and social media. METHODS:A cross-sectional design was employed. Participants completed an electronic survey consisting of a demographic form and the PSS-10 and OLBI measures. Data were analyzed using IBM SPSS Statistics, with one-way ANOVAs conducted to assess differences between demographic groups. This study was conducted midway through the COVID-19 pandemic. RESULTS:The mean PSS-10 score was 15, indicating moderate stress for 56.1% of participants. The mean OLBI score was 36.95, indicating moderate burnout for 65.4% of participants. Significant differences between groups in both stress and burnout were found across age and marital status variables. Notably, women reported higher burnout levels than men. DISCUSSION AND CONCLUSION:Physical Therapy Clinical Instructors exhibit moderate stress and burnout levels, similar to general PT populations. The findings highlight the need for targeted interventions supporting PT CIs, particularly considering the COVID-19 pandemic impact. Future research should explore additional factors influencing PT CI stress and burnout and develop strategies of mitigation.

Context: The Patient Reported Impact of Spasticity Measure (PRISM) is a self-reported questionnaire that is used to assess the impact of spasticity on the quality of life of individuals with spinal cord injury (SCI). Its inclusion in the assessment process for patients living in a country such as Saudi Arabia, which has one of the highest incidences of SCI around the world, will be an integral addition. Aims: The aims for this study were to translate and cross-culturally adapt the PRISM into Arabic and pilot test the Arabic version on Arabic speakers with SCI in Saudi Arabia. Settings and Design: Translation process was administered according to the recommended guidelines used for cross-cultural adaptation of healthcare measures. Methods and Material: Pilot testing of the PRISM-Arabic was administered to 35 individuals with SCI presenting with spasticity. Participants were interviewed to assess the relevance of the questionnaire to the Arabic language and culture. Face and content validity of the PRISM-Arabic as well as its floor and ceiling effects were assessed. Results: During the translation process, the expert committee made changes in 14 occasions due to cultural equivalence differences. Pilot-testing showed eight items that needed further adaptation. After all were made, the cross-culturally adapted PRISM-Arabic showed adequate face and content validity and did not have flooring and ceiling effects. Conclusions: The PRISM has been successfully translated and cross-culturally adapted into Arabic language. Further assessments of its psychometric properties are recommended. Implications for its use in clinical practice and research were presented. Key-words: Spinal cord injury, Spasticity, Patient Reported Impact of Spasticity Measure, PRISM Key Messages: The PRISM was successfully translated and cross-culturally adapted for Arabic speakers with SCI reporting spasticity. The introduction of such spasticity-specific self-reported outcome measure into clinics in Saudi Arabia is the first of its kind. The PRISM will introduce a new area of research and clinical assessment related to patients with SCI.

A survey was completed by 183 clinicians at a pediatric hospital to investigate knowledge, confidence, and practice patterns defining, identifying, and quantifying dystonia in children. The definition of dystonia was correctly identified by 86% of participants. While 88% reported identifying dystonia, only 42% of physicians and therapists reported quantifying dystonia. A weak, significant correlation, rs =.339, p <= .001, was found between years of pediatric experience and confidence identifying dystonia. Clinician reported higher confidence levels identifying and quantifying dystonia if they perform a neurological exam. Clinical training initiatives are needed to improve standardization and build confidence in defining, identifying, and quantifying dystonia.

Introduction. In May 2022, the American Council of Academic Physical Therapy announced a “nationwide shortage of faculty” in entry-level Doctor of Physical Therapy (DPT) programs across the country. As the number of physical therapist education programs continue to grow, concerns with faculty shortages increase. Review of Literature. Research on reasons faculty stay in entry-level DPT programs is limited. With a nation-wide shortage of faculty and the continued growth of DPT programs across the country, more investigation into faculty retention is warranted. Subjects. Two hundred forty-four participants responded to the quantitative survey. Ten program directors (PD) and 10 faculty members (FM) completed a qualitative interview through Zoom. Methods. This mixed-methods design included a quantitative survey across 264 accredited DPT programs followed by 20 qualitative online interviews. Multiple regression was completed for the data analysis, and a phenomenological approach was used to explore perceptions of job satisfaction and organizational commitment on intent to stay. Results. Two hundred thirty-six subjects (mean age = 50.04 ± 9.54 years; males = 63, females = 173; PD = 55, FM = 180) were included in the analysis. The multiple regression model significantly predicted intent to stay for all participants, F(9,211) = 12.43, P < .001; adj R 2 = .32. Commitment to the organization was the greatest predictor of intent to stay, β = 0.61, t(0.622) = 5.05, P < .01. Three themes with 6 subthemes emerged from the qualitative analysis, the impact of leadership, making a commitment, and the Covid crisis. Conclusion and Discussion. Encouraging leadership to focus on structural factors such as striving to establish FMs as part of the departmental team, allowing autonomy and flexibility in the teaching role, building transparency and openness with communication, and focusing on realistic and equitable workloads could potentially increase intent to stay for faculty in entry-level DPT programs.

Purpose: The aim of this study was to describe existing GoBabyGo (GBG) programs with physical or occupational therapist (PT or OT) involvement and identify eligibility criteria and evaluation processes of organizations that build modified ride-on cars (MROCs). Methods: Forty-four PTs and OTs completed a survey including descriptive information about GBG programs, barriers and facilitators, and functional aspects of the programs such as inclusion and exclusion criteria, outcome measure use, and follow-up practices. Results: Findings demonstrated the heterogeneous nature of GBG programs. GBG programs most commonly serve 2 to-5-year-olds with cerebral palsy, spina bifida, and chromosomal abnormalities. Outcome measure use and follow-up was minimal, and successful MROC use definitions varied from independent driving to passive use. Conclusions: Clinicians can use this information to help improve existing GBG programs and start new chapters as well as make appropriate referrals for clients who may benefit from a MROC.

Journal Article Comparison of those with high versus low kinesiophobia on the lower body positive pressure treadmill Get access Rebecca Greenwood, PhD, Rebecca Greenwood, PhD Department of Health and Human Services, School of Physical Therapy, Texas Woman’s University, Houston, TX 77030, United States Corresponding author: Department of Health and Human Services, School of Physical Therapy, Bowling Green State University, 104 Health and Human Services Building, Bowling Green, OH 43403, USA. Email: Greenra@bgsu.edu https://orcid.org/0000-0002-4888-8040 Search for other works by this author on: Oxford Academic PubMed Google Scholar Jennifer Ellison, PhD, Jennifer Ellison, PhD Department of Health and Human Services, School of Physical Therapy, Texas Woman’s University, Houston, TX 77030, United States Search for other works by this author on: Oxford Academic PubMed Google Scholar Peggy Gleeson, PhD, Peggy Gleeson, PhD Department of Health and Human Services, School of Physical Therapy, Texas Woman’s University, Houston, TX 77030, United States Search for other works by this author on: Oxford Academic PubMed Google Scholar Katy Mitchell, PhD Katy Mitchell, PhD Department of Health and Human Services, School of Physical Therapy, Texas Woman’s University, Houston, TX 77030, United States Search for other works by this author on: Oxford Academic PubMed Google Scholar Pain Medicine, Volume 24, Issue 8, August 2023, Pages 1011–1013, https://doi.org/10.1093/pm/pnad021 Published: 20 February 2023 Article history Received: 30 December 2022 Revision received: 03 February 2023 Accepted: 13 February 2023 Published: 20 February 2023 Corrected and typeset: 05 July 2023

Background The use of balance outcome measures (OM) is proposed to enhance physical therapy services and patient outcomes. Objective Explore current practices of balance OM use and OM's role in United States physical therapists' decision-making with patient's acquired brain injury (ABI). Methods Cross-sectional survey utilizing snowball sampling, n = 373. Survey items required ranking agreement with statements on Likert scale. Multinomial logistic regression used to determine the relationship between survey answers and participant characteristics. Results Ninety-three percent of therapists reported using outcome measures with patients with ABI. Those who reported not using outcome measures with patients with ABI were significantly different on setting, primary patient population, APTA section membership, and ANPT membership. All respondents who primarily treated neurologic diagnoses used outcome measure with clients with ABI, compared to 87% of respondents who worked primarily with orthopedic clients. Comfort, equipment availability, and psychometric properties were the most frequent reasons for choosing a measure. Therapist decision-making was impacted by outcome measures; this frequency was dependent on practice setting, primary patient population, and specialty certifications. Conclusions Physical therapists use a low diversity of outcome measures to assess balance. Respondents rated psychometric properties as more important than past published research. This is the first study to demonstrate that outcome measures play a role for most United States PTs in decision-making in all stages of the patient management model including identification of problems, diagnosis, prognosis, intervention selection, termination of services, and discharge planning, as well justifying service delivery.

Purpose: Muscle elasticity can be quantified with shear wave elastography (SWE) and has been used as an estimate of muscle force but reliability has not been established for lower leg muscles. The purpose of this study was to examine the intra-rater and inter-rater reliability of elasticity measures in non-weight-bearing (NWB) and weight-bearing (WB) for the tibialis anterior (TA), tibialis posterior (TP), peroneal longus (PL), and peroneal brevis (PB) muscles using SWE.Methods: A total of 109 recreationally active healthy adults participated. The study employed a single-cohort, same-day repeated-measures test-retest design. Elasticity, measured in kilopascals as the Young's modulus, was converted to the shear modulus. All four muscles were measured in NWB and at 90% WB.Results: Intra-rater reliability estimates were good to excellent for NWB (ICC = 0.930-0.988) and WB (ICC = 0.877-0.978) measures. Inter-rater reliability estimates were moderate to good (ICC = 0.500-0.795) for NWB measures and poor to good (ICC = 0.346-0.910) for WB measures.Conclusion: Despite the studies poor to good inter-rater variability, the intra-rater reproducibility represents the potential benefit of SWE in NWB and WB. Establishing the reliability of SWE with clinical and biomechanical approaches may aid in improved understanding of the mechanical properties of muscle.

Purpose The use of outcome measures (OMs) is a hallmark of contemporary physical therapy in the USA. The effect of OM utilization on patient care decisions and the results of PT services remain poorly understood. The purpose of this study is to explore PTs perceptions about the relationship between balance OMs and decision-making and how that interaction impacts patient outcomes, particularly for patients with acquired brain injury. Materials and methods This qualitative study used semi-structured phone interviews with an interview guide. Maximum variation sampling was used. Thematic analysis was situated in a priori determined theory-based categories. Results Twenty-three physical therapists (PTs) from diverse geographic areas and practice settings participated. Therapists expressed diverse views on the impact of OM use on patient outcomes, but the majority perceived that using OMs improved rehabilitation outcomes. The use of OMs was related to the selection of optimal intervention type and intensity and justified continued high-frequency rehabilitation services. OMs were important to therapists' decision-making. Conclusions In the present study, PTs reported that they believe the use of validated, clinically useful OMs may improve patient outcomes.