BACKGROUND AND PURPOSE:It is unknown how Patient-Reported Outcomes Measures Information System Physical Function (PROMIS-PF) corresponds to physical abilities and common performance-based measures of function in patients with neurologic conditions/disorders in outpatient, ambulatory settings. The purpose of this study was to evaluate the association between PROMIS-PF and common performance-based measures of function in patients with neurologic conditions receiving outpatient physical therapy (PT). METHODS:A retrospective analysis of clinical data was conducted from 11 outpatient neurologic PT clinics within a large health care system between 12/2/2019 and 12/30/2022. Adult patients with neurologic conditions who had at least one performance-based functional measure [Timed up and go (TUG), 5 times sit to stand (5 × STS), and 10-m walk test (10 MWT)] and one PROMIS-PF score within 7 days were included. Pearson correlations and linear regression models were used to examine the relationships between the PROMIS-PF and performance-based measures. RESULTS:In our study of 1712 patients (average age 59 (SD 16) years, 44% male, 81% white race), there was a moderate relationship between PROMIS-PF and TUG and PROMIS-PF and 5 × STS (r = -0.31 and -0.38, respectively; p < 0.001). There was a strong association between PROMIS-PF and 10 MWT (r = 0.60; p < 0.001). In linear regression models, the variation in PROMIS-PF explained by the performance measures was the highest for 10 MWT (34.8%), followed by 5 × STS, and TUG (13.5% and 9%, respectively). DISCUSSION:Results demonstrated moderate associations between PROMIS-PF and performance-based measures. Both types of measures provide complementary clinical information for outpatients with neurological conditions.

# Background The sport of rifle places unique physical demands on its athletes relative to other collegiate sports, including maintaining lumbar-straining positions for extended time. Anecdotal reports of low back pain (LBP) are common among collegiate rifle athletes, but the prevalence of LBP in this population has not yet been established in the literature. # Purpose The purpose of this study was to survey collegiate rifle athletes to quantify the prevalence and impact of low back pain in this population and identify possible contributing factors including the COVID-19 pandemic. It was hypothesized that over 50% of athletes would report an episode of LBP due to participation in collegiate rifle events. # Study Design Cross-Sectional Study # Methods Athletes at least 18 years of age who were members of a collegiate rifle program during the 2019-2020 season were surveyed via an online questionnaire. The questionnaire included four sections: (a) demographics, (b) presence of LBP, (c) the impact of pain episodes on daily activities, and (d) shooting stance and training characteristics. # Results Responses from 114 athletes were collected. A total of 101 (89%) respondents indicated having experienced at least one episode of LBP. Of those, 24% also missed at least one day of training or competition during the 2019-2020 season because of LBP. During the COVID-19 pandemic, 60% were unable to receive the same level of medical care while 69% experienced equal or greater pain levels. An association between sex and LBP was statistically significant (p<0.001). # Conclusion There is a high prevalence of LBP in collegiate rifle athletes. It is necessary for Athletic Training staff and other medical professionals to be aware of this for prevention and treatment, as it has significant impacts including missed playing time. More research on predisposing factors such as sex and training duration or positional characteristics would benefit management of this injury. # Level of Evidence 3

Background Joint hypermobility is common in children and persists in various genetic and connective tissue disorders, including conditions characterized by chronic musculoskeletal pain (i.e. Juvenile Fibromyalgia Syndrome), which involves movement dysfunction. It is unclear if joint hypermobility contributes to this dysfunction. This study investigated whether generalized joint hypermobility is associated with altered landing/jumping biomechanics in adolescents with juvenile fibromyalgia syndrome compared to controls. Methods Adolescents with juvenile fibromyalgia syndrome and hypermobility (n = 17), juvenile fibromyalgia syndrome without hypermobility (n = 17), and non-hypermobile controls (n = 17) performed a landing/jumping task while 3D-motion capture and ground reaction force data were collected. Timewise data were compared using statistical parametric mapping. Findings Both groups with juvenile fibromyalgia syndrome exhibited altered lower extremity biomechanics compared to controls, including increased sagittal hip and ankle kinematics (P < 0.0001), similar to 25 % reduced sagittal knee and ankle kinetics (P <= 0.038) and similar to 2.5x greater knee internal rotation (P < 0.0001) during landing/jumping, as well as similar to 75 % and similar to 20 % reduced ground reaction force during initial landing and jumping (P < 0.0001), respectively. Both groups with juvenile fibromyalgia syndrome, demonstrated 17-26 % reduced landing depth (P < 0.0001;d <= 1.79) and 26 % reduced jump height (P <= 0.01;d <= 0.86), indicating inefficient momentum absorption. Interpretation Altered biomechanics observed in both groups with juvenile fibromyalgia syndrome may reflect an attempt to avoid pain. While hypermobility did not significantly differentiate the groups with juvenile fibromyalgia syndrome overall, it was associated with more inefficiencies. This study highlights the need for hypermobility-specific movement assessments to understand movement-associated pain, strength, and kinesthetics to improve early identification and treatment of youth with hypermobility at risk for chronic pain and functional limitations.

INTRODUCTION:Emerging evidence shows positive impact of postprofessional physical therapy education (residency and fellowship) specific to participants; however, outcomes on organizational impact are largely unknown. The purpose of this project was to describe the impact residency and fellowship training has on financial metrics. A secondary purpose of this case study was to describe trends associated with higher productivity. REVIEW OF LITERATURE:Previous studies have demonstrated positive professional behavior and generalized operational impact of postprofessional education. No studies have evaluated the impact of residency and fellowship training on individual physical therapist (PT) productivity. SUBJECTS:Individual productivity from 191 PTs was collected over a 10-year time frame from a large, ambulatory, rehabilitation department within an academic medical center. Productivity was compared between 4 groups: nonresidency- or fellowship-trained clinicians; residency-trained clinicians; fellowship-trained clinicians; and dual residency and fellowship-trained clinicians. METHODS:Physical therapists' productivity data were manually extracted retrospectively from operational reports over a 10-year period. Additional data elements extracted included the following: board specialty certification and years employed at the medical center. Data were then categorized as nonresidency/fellowship -trained, residency trained, fellowship trained, or dual residency and fellowship trained. Data were analyzed using descriptive statistics and 1-way analysis of variance (ANOVA). RESULTS:Forty-five clinicians with postprofessional training collectively produced $253,617 more in financial annual return to the organization. Fellowship-trained clinicians demonstrated the highest productivity followed by residency-trained and dual residency and fellowship-trained clinicians. Specialty board certification also positively increased productivity regardless of postprofessional training. DISCUSSION AND CONCLUSION:Postprofessional training within physical therapy continues to be evaluated in the spectrum of professional development. Evidence supports positive professional behaviors and patient outcomes; however, little is known regarding its impact on productivity metrics. Although no significance was found between the groups with and without postprofessional training, meaningful financial return was demonstrated in clinicians with postprofessional training. The lack of significance may have been influenced by compression because of departmental productivity guidelines. This preliminary data may assist organizations in justifying resources for sustaining and sponsoring future programs.

This Perspective provides a crucial set of actions with corresponding recommendations aimed at propelling the physical therapy profession toward excellence in residency education. The conceptual model includes elements of excellence in the delivery and outcomes of physical therapist residency education and the domain of value experienced by stakeholders impacted by physical therapist residency education. Linked to the conceptual model, the 15 actions, and 28 recommendations draw from (1) the Physical Therapist Residency Excellence and Value (PT-REV) study, (2) the Physical Therapist Education for the 21st Century (PTE-21) study, and (3) research in the learning sciences. This paper proposes a transformative call for decisive and consistent reform directed toward residency programs, residents, sponsoring organizations, and the physical therapy profession. Physical therapist residency education, initiated over 23 years ago, is no longer in its infancy with critical gaps in its maturation that need to be addressed systematically by stakeholders across the profession, thus improving the profession's ability to respond to changing societal needs. This Perspective serves as a call to action and provides specific recommendation for what is needed to promote and achieve excellence in physical therapist residency education to improve the professions' ability to adapt to changing societal needs.

Physical activity avoidance and fear of movement (FOM) is often observed in individuals with chronic musculoskeletal pain, along with difficulties coping with pain. There is little research regarding how FOM may also relate to reduced physical strength and altered movement patterns that may perpetuate a cycle of pain, FOM, and disability. The objective of this observational study was to compare how adolescents with juvenile fibromyalgia (JFM) exhibiting high versus low FOM (Tampa Scale of Kinesiophobia-11) differed on patient-reported measures of pain, fatigue, catastrophizing and pain interference, and performance-based measures of strength, postural control, and biomechanical function. Participants were youth with JFM (N = 135, Meanage = 15.6 years, 88.9% female) enrolled in an ongoing clinical trial who completed self-report questionnaires and standardized tests, including knee and hip strength, the Star Excursion Balance Test, and the Drop Vertical Jump (with 3 dimensional motion capture). Participants were categorized into Low, Medium, and High FOM groups based on Tampa Scale of Kinesiophobia-11 tertile scores. Relative to the Low FOM group, the High FOM group reported significantly greater fatigue, pain interference and catastrophizing, as well as reduced dominant leg knee strength. Additionally, those with high FOM showed altered lower-extremity movement patterns. This preliminary study highlights the importance of combining self-reported measures of symptoms and functioning with physical assessments to gain a more comprehensive view of the impact of FOM in patients with chronic musculoskeletal pain. The results could inform the development of more precise interventions to reduce FOM using a combination of behavioral and exercise-based interventions. Perspective: The results of this study demonstrate the association between FOM, fatigue and pain interference in adolescents with JFM, as well as preliminary evidence for altered movement patterns in that may predispose them to further pain/injury and activity avoidance. rights are reserved, including those for text and data mining, AI training, and similar technologies.

BackgroundLow back pain (LBP) is the number one cause of disability worldwide; however, it is not clear how social determinants of health (SDOH) impact care management and outcomes related to physical therapy (PT) services for patients with LBP.ObjectiveThe purposes of this scoping review are to examine and assimilate the literature on how SDOH and PT care relate to non-specific LBP outcomes and identify gaps in the literature to target for future research.MethodsData were extracted from eight electronic databases from January 2011 to February 2022. Reviewers independently screened all studies using the PRISMA extension for scoping review guidelines. Data related to study design, type of PT, type of non-specific LBP, patient demographics, PT intervention, SDOH, and PT outcomes were extracted from the articles.ResultsA total of 30,523 studies were screened, with 1961 articles undergoing full text review. Ultimately, 76 articles were identified for inclusion. Sex and age were the most frequent SDOH examined (88% and 78% respectively) followed by education level (18%). Approximately half of the studies that examined age, sex, and education level identified no effect on outcomes. The number of studies examining other factors was small and the types of outcomes evaluated were variable, which limited the ability to pool results.ConclusionsSex and age were the most frequent SDOH examined followed by education level. Other factors were evaluated less frequently, making it difficult to draw conclusions. Study design and heterogeneity of determinants and outcomes were barriers to examining the potential impact on patients with LBP.

ABSTRACT:Juvenile fibromyalgia (JFM) is a chronic condition characterized by symptoms of pain and fatigue and is associated with sedentary behavior and functional disability. Adults with fibromyalgia exhibit deficits in physical fitness as evidenced by lower aerobic capacity and physical endurance, but it is unknown whether these impairments are apparent in adolescents with JFM. Furthermore, the extent to which functional disability and pain interference relate to measures of physical fitness has not been investigated in a pediatric pain population. During a baseline assessment for a clinical trial, 321 adolescents with juvenile fibromyalgia (M age = 15.14, 85.2% female) completed measures of pain intensity, fatigue, JFM symptom severity, functional disability, and pain interference. They also completed 2 validated fitness tasks: (1) the Harvard step test, which assesses aerobic fitness, and (2) the 6-minute walk test, a simple submaximal test of endurance. We examined associations among self-report measures and fitness assessments using bivariate correlations. We then employed hierarchical regression analyses to determine the unique contributions of physical fitness assessments to self-reported functional disability and pain interference. Results indicated that youth with JFM exhibited deficits in aerobic capacity and physical endurance. However, physical fitness explained negligible variance in functional disability and pain interference beyond that accounted for by pain, fatigue, and JFM symptom severity. Scores on available functional disability measures may reflect perceived difficulties in coping with symptoms during physical tasks rather than actual physical capability. Rigorous and sensitive assessments of physical fitness and endurance are needed to determine whether rehabilitation interventions for pediatric pain improve physical functioning.

Objective: A challenge in health professions is training practitioners to navigate health care complexities, promote health, optimize outcomes, and advance their field. Physical therapist residency education offers a pathway to meet these needs in ways that "entry-level" (professional) education may not. Identifying key aspects of excellence in residency education and understanding its value in developing adaptive expertise will help devise strategies to enhance program, resident, and patient outcomes. The objective of this study was to examine current physical therapist residency education practices to identify and describe examples of excellence and value. Methods: A multi-site, multi-specialty qualitative case series was conducted, examining exemplary physical therapist residency programs and their contextual environments using a social constructivist theoretical lens. Six residency programs operating 20 individual residencies that were considered exemplar were selected for the study to participate in site visits. Qualitative case studies were generated from individual interviews, focus groups, review of artifacts, and field observations. The residencies were diverse in specialty area of practice, setting, and geographic location. Results: A conceptual framework was generated grounded in the domains of excellence and value. These domains were connected by 3 signature indicators: (1) atmosphere of practice-based learning, (2) embodiment of professional formation, and (3) elevated practice. These signature indicators represent the aggregate effects of the interchange between the excellence and value domains which sustain residency education. Conclusion: This study builds upon the work of the Physical Therapist Education for the 21st Century (PTE-21) study and identifies key elements of excellence in residency education, the value of such education, and related outcomes. Findings from this study substantiate the need for a postprofessional phase of physical therapist education founded in practice-based learning encapsulated in residency education. Impact: Results from this study could have compelling and powerful implications on the dialogue and strategic direction in physical therapist residency education.

There is limited high level research supporting the use of dry needling for mechanical shoulder pain. Dry needling is often used as an adjunct or primary treatment for musculoskeletal pain to address impairments related to muscle pain, range of motion (ROM), and strength deficits. This case study describes a 68-year-old female referred from her Physician to physical therapy (PT) with diagnosis of shoulder impingement syndrome. She underwent 12 sessions of traditional PT including manual therapy and therapeutic exercises with moderate pain reductions, improved ROM, and optimal functional outcomes using the Quick DASH. However, when progress was stalled, Dry needling (DN) was included in the plan of care. Dry needling was then performed as primary treatment to the anterior muscles of the shoulder (pectoralis major, pectoralis minor near the musculotendinous junction), and the latissimus, subscapularis and anterior deltoid) for two treatments resulting in significant improvements with ROM, reduced pain and improved functional outcomes which continued at 6-months with follow- up with patient.

BACKGROUND: Glioblastoma is a primary brain tumor that shares symptoms with orthopaedic conditions like low back pain with radiating pain. The purpose of this case study was to describe a patient referred to physical therapy (PT) and subsequently diagnosed with a glioblastoma. CASE PRESENTATION: A 64-year-old male was referred to PT with right foot numbness and lower back pain. Initially, the patient was diagnosed with chronic low back pain with radiating pain (International Classification of Diseases and Related Health Problems, 10th Revision) related to lumbar spinal stenosis, and initial treatment resulted in significant reduction of foot numbness. After initial improvement, he reported an insidious onset of fasciculations and lacked response to therapy interventions, which warranted referral for imaging. OUTCOME AND FOLLOW-UP: Magnetic resonance imaging of the brain revealed high-grade glioblastomas, and the patient underwent a craniotomy for tumor resection with subsequent chemotherapy and radiation. DISCUSSION: Glioblastoma is an underreported condition in PT literature, and increased awareness of symptoms can improve recognition and appropriate referral. JOSPT Cases 2023;3(4):219-226. Epub 25 September 2023. doi:10.2519/josptcases.2023.11913

BACKGROUND: The regional interdependence model is an approach that can assist in better discerning complex symptom presentations and developing a specific plan of care. CASE PRESENTATION: A 33-year-old female equine stable worker presented with reports of chronic axillary pain limiting work participation. Objective testing revealed radiating axillary pain with thoracic and rib testing, scapular dyskinesis with shoulder girdle and kinetic chain strength deficits, and thoracic spine hypomobility. OUTCOME AND FOLLOW-UP: The patient returned to full-time work in 3 sessions with treatment focused on thoracic/rib mobilization and shoulder loading. Full recovery was facilitated through combined kinetic chain and functional shoulder loading. DISCUSSION: The principles of regional interdependence can play a role in effective and efficient diagnosis and treatment of many orthopaedic conditions. Considering regional interactions can be particularly important for both differential diagnosis and treatment of patients with orthopaedic pathologies where the pain generator is unclear, such as axillary pain. JOSPT Cases 2023;3(1):59–73. Epub: 4 November 2022. doi:10.2519/josptcases.2022.11295

Introduction. Understanding how educational pathways may influence clinical competence and work responsibilities is important in providing guidance to academic and clinic stakeholders and physical therapists (PTs) on PT career development. The purpose of this paper was to compare perceived clinical competency and job duties between PTs with formal mentored postprofessional clinical education with PTs without formal postprofessional clinical education. Review of Literature. The understanding of self-perceived clinical competence of PTs overall in the United States is limited, especially as related to the impact of postprofessional education. Furthermore, there is limited understanding of the career pathways and development of job duties of PTs in the United States. Subjects. Two thousand three hundred thirty-four PTs in the United States. Methods. An online survey was sent to licensed PTs. This survey included items measuring self-perceived clinical competency and questions related to weekly job responsibilities. Participants were categorized as residency trained, fellowship trained, or non–residency/fellowship trained. Frequency analyses and Kruskal–Wallis tests with pairwise post hoc tests were performed comparing the 3 groups. Results. Residency-trained ( P < .007) and fellowship-trained ( P < .001) groups demonstrated elements of higher self-perceived clinical competency compared with the non–residency-/fellowship-trained group. Both the residency- and fellowship-trained groups spent less time with patient care and more time with other responsibilities (e.g., teaching, mentoring, and research) ( P < .02) during an average workweek. Fellowship-trained PTs ( P < .001) spent more time with administrative duties compared with the non–residency-/fellowship-trained group. Discussion and Conclusion. Results from this paper demonstrate that residency- and fellowship-trained PTs have elements of higher self-perceived clinical competency and spend more of their job duties outside of direct patient care compared with PTs who were not residency or fellowship trained. These results may help guide PTs, academic institutions, and employers in planning and achieving specific career paths.

Objective The aim of this systematic review and correlation meta-analysis was to identify factors associated with kinesiophobia in individuals with patellofemoral pain (PFP) and to identify interventions that may reduce kinesiophobia in individuals with PFP.Methods Seven databases were searched for articles including clinical factors associated with kinesiophobia or interventions that may reduce kinesiophobia in individuals with PFP. Two reviewers screened articles for inclusion, assessed risk of bias and quality, and extracted data from each study. A mixed-effects model was used to calculate correlations of function and pain with kinesiophobia using individual participant data. Meta-analyses were performed on interventional articles; Grading of Recommendations, Assessment, Development, and Evaluation was used to evaluate certainty of evidence. Results were reported narratively when pooling was not possible.Results Forty-one articles involving 2712 individuals were included. Correlation meta-analyses using individual participant data indicated a moderate association between self-reported function and kinesiophobia (n = 499; r = -0.440) and a weak association between pain and kinesiophobia (n = 644; r = 0.162). Low-certainty evidence from 2 articles indicated that passive treatment techniques were more effective than minimal intervention in reducing kinesiophobia (standardized mean difference = 1.11; 95% CI = 0.72 to 1.49). Very low-certainty evidence from 5 articles indicated that interventions to target kinesiophobia (psychobehavioral interventions, education, and self-managed exercise) were better in reducing kinesiophobia than physical therapist treatment approaches not specifically targeting kinesiophobia (standardized mean difference = 1.64; 95% CI = 0.14 to 3.15).Conclusion Higher levels of kinesiophobia were moderately associated with poorer function and weakly associated with higher pain in individuals with PFP. Taping and bracing may reduce kinesiophobia immediately after use, and specific kinesiophobia-targeted interventions may reduce kinesiophobia following the full intervention; however, the certainty of evidence is very low.Impact Assessment of kinesiophobia in clinical practice is recommended, on the basis of the relationships identified between kinesiophobia and other important factors that predict outcomes in individuals with PFP.

OBJECTIVE:Evaluate how Graded Motor Imagery (GMI) may be used in those with knee pain, if individuals with knee pain present with a central nervous system (CNS) processing deficit, and if GMI is associated with improved outcomes.METHODS:An electronic database search was conducted of PubMed, SPORTDiscus, CINHAL, MEDLINE, Google Scholar, and Sports Medicine Education Index using keywords related to GMI and knee pain. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Out of the 13,224 studies reviewed, 14 studies were included that used GMI for knee pain. Effect sizes were reported with standardized mean differences (SMD).RESULTS:Individuals with knee osteoarthritis demonstrated poor performance with correctly identifying images of left or right knees, and GMI improved performance. In contrast, individuals with an anterior cruciate ligament injury demonstrated no evidence of CNS processing deficit and mixed outcomes with GMI. Meta-analysis was limited to individuals post total knee arthroplasty showing low certainty that GMI can improve quadriceps force production [SMD 0.64 (0.07,1.22)], but evidence of no effect to reduce pain or improve Timed up and Go performance and self-reported function.CONCLUSIONS:Graded motor imagery may be an effective intervention for individuals with knee osteoarthritis. However, there was limited evidence that GMI was effective for an anterior cruciate ligament injury.

BACKGROUND Patients who were incarcerated were disproportionately affected by COVID-19 compared with the general public. Furthermore, the impact of multidisciplinary rehabilitation assessments and interventions on the outcomes of patients admitted to the hospital with COVID-19 is limited. OBJECTIVE We aimed to compare the functional outcomes of oral intake, mobility, and activity between inmates and noninmates diagnosed with COVID-19 and examine the relationships among these functional measures and discharge destination. METHODS A retrospective analysis was performed on patients admitted to the hospital for COVID-19 at a large academic medical center. Scores on functional measures including the Functional Oral Intake Scale and Activity Measure for Postacute Care (AM-PAC) were collected and compared between inmates and noninmates. Binary logistic regression models were used to evaluate the odds of whether patients were discharged to the same place they were admitted from and whether patients were being discharged with a total oral diet with no restrictions. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. RESULTS A total of 83 patients (inmates: n=38; noninmates: n=45) were included in the final analysis. There were no differences between inmates and noninmates in the initial (P=.39) and final Functional Oral Intake Scale scores (P=.35) or in the initial (P=.06 and P=.46), final (P=.43 and P=.79), or change scores (P=.97 and P=.45) on the AM-PAC mobility and activity subscales, respectively. When examining separate regression models using AM-PAC mobility or AM-PAC activity scores as independent variables, greater age upon admission decreased the odds (OR 0.922, 95% CI 0.875-0.972 and OR 0.918, 95% CI 0.871-0.968) of patients being discharged with a total oral diet with no restrictions. The following factors increased the odds of patients being discharged to the same place they were admitted from: being an inmate (OR 5.285, 95% CI 1.334-20.931 and OR 6.083, 95% CI 1.548-23.912), “Other” race (OR 7.596, 95% CI 1.203-47.968 and OR 8.515, 95% CI 1.311-55.291), and female sex (OR 4.671, 95% CI 1.086-20.092 and OR 4.977, 95% CI 1.146-21.615). CONCLUSIONS The results of this study provide an opportunity to learn how functional measures may be used to better understand discharge outcomes in both inmate and noninmate patients admitted to the hospital with COVID-19 during the initial period of the pandemic.

BACKGROUND:There is a relationship between low back pain (LBP) and central nervous system dysfunction. Needling therapies (e.g. acupuncture, dry needling) are proposed to impact the nervous system, however their specific influence is unclear. PURPOSE:Determine how needling therapies alter functional connectivity and LBP as measured by functional magnetic resonance imaging (fMRI). METHODS:Databases were searched following PRISMA guidelines. Studies using fMRI on individuals with LBP receiving dry needling or acupuncture compared to control or sham treatments were included. RESULTS:Eight studies were included, all of which used acupuncture. The quality of studies ranged from good (n = 6) to excellent (n = 2). After acupuncture, individuals with LBP demonstrated significant functional connectivity changes across several networks, notably the salience, somatomotor, default mode network (DMN) and limbic networks. A meta-analysis demonstrated evidence of no effect to potential small effect of acupuncture in reducing LBP (SMD -0.28; 95% CI: -0.70, 0.13). CONCLUSION:Needling therapies, like acupuncture, may have a central effect on patients beyond the local tissue effects, reducing patients' pain and disability due to alterations in neural processing, including the DMN, and potentially other central nervous system effects. The meta-analysis should be interpreted with caution due to the narrow focus and confined sample used.

Introduction. Mentoring and professional development opportunities influence job and career satisfaction. Review of the Literature. Job and career satisfaction are multifactorial. The purpose of this study was to compare job and career satisfaction between physical therapists (PTs) who were residency trained and PTs who were neither residency nor fellowship trained and between PTs who were fellowship trained and PTs who were neither residency nor fellowship trained. Subjects. Licensed PTs in the United States. Methods. An online survey was distributed asking questions regarding job satisfaction and career satisfaction. Respondents were categorized as completing a residency, fellowship, both, or neither. Responses were respectively summed, then compared between groups: residency versus nonresidency/nonfellowship and fellowship versus nonresidency/nonfellowship. Frequency analyses and Mann–Whitney U tests were performed. Results. A total of 3,080 survey responses were analyzed. Residency-trained PTs had an overall higher job satisfaction score (P = .03) and higher career satisfaction score (P = .05) when compared with non–residency-trained or non–fellowship-trained PTs. Fellowship-trained PTs reported higher job satisfaction (P < .001) and career satisfaction (P = .001) compared with non–residency-trained or non–fellowship-trained PTs. Residency-trained PTs rated the importance of their work being interesting and learning/improving in their work of greater importance to their job satisfaction compared with non–residency-trained or non–fellowship-trained PTs (P < .05). Whereas, fellowship-trained PTs rated factors such as their jobs being positively challenging, fulfilling, and interesting, having sufficient independence, and were learning/improving in their work of greater importance than non–residency-trained and non–fellowship-trained PTs (P ≤ .004). Discussion and Conclusion. Results from the study support previous evidence that PTs overall have high job/career satisfaction and residency/fellowship training may further enhance job and career satisfaction. Findings provide valuable insight and are relevant to all PTs as well as stakeholders involved in professional and postprofessional physical therapy education and those making hiring decisions and potential employment opportunities.