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PubMed1979

Physical therapists' knowledge of sexuality of adults with spinal cord injury.

Helping the adult with spinal cord injury to adjust to sexual limitations is an important and neglected part of his rehabilitation. Health professionals of all fields have been perceived to be deficient in their knowledge of the sexuality of the adult with spinal cord injury. A test with 40 statements reflecting myths, misconceptions, and truths about the effect of spinal cord injury on sexual function was administered to 30 physical therapists responsible for rehabilitating these adults. At least 28 of the 40 items were missed by 10 percent or more of the therapists. Experience and participation in educational programs appeared to contribute to the respondents' knowledge, as reflected by the test, but only experience was a statistically significant variable.

Attitude↗

PubMed1984

Existential-behaviour therapy: a possible paradigm?

A comparative discussion is presented of existential and behavioural psychotherapy, indicating where behavioural theory, empirical research and single case studies can be related to the existential emphasis on phenomenology and personal confrontation with death, freedom, isolation and meaninglessness. The conclusions are that: more recent emphasis on cognitive variables in behaviour therapy has brought the two conceptual systems closer together; and there is improvement in the understanding of aetiology and clinical effectiveness when the therapist incorporates existential-behavioural constructs and methods of working.

Attitude to Death↗

PubMed1995

Studies on the efficacy of unconventional therapies. Problems and designs.

Many unconventional therapies (e.g. dietary, phytotherapy, acupuncture, homeopathy) are well known and often applied, but their efficacy has hardly been proven. New trial designs and study components must be found to meet the specific demands of the particular unconventional therapy on one hand and keep the high methodological standard of controlled clinical trials on the other hand. Biometricians and unconventional therapists are challenged to develop such designs. Typical problems in designing studies of unconventional therapies include that placebo is not possible, therapies cannot be masked, outcome variables are not reliable, therapy is highly individualized, and studies on the efficacy of soft therapies require many patients and long treatment periods. Studies with unconventional therapies should be performed by practitioners (because they use these therapies), but this leads to further problems. Some solutions are given in examples: A study is described investigating the herbal remedy Kava-Kava for patients in the state of anxiety, tension and restlessness; a study on classical homeopathy for chronical headaches is specified; some designs for dietary studies in patients with rheumatoid arthritis are compared. A design called "cross-allocation of patients to two treatments with randomization option" and the "N-of-1 design", also called "single case design" are described and discussed. The "change-to-open-label design" could be useful to investigate soft and natural therapies which require studies with many patients and long-term treatment.

Arthritis, Rheumatoid↗

PubMed1998

Does academic training background make a difference among practicing marriage and family therapists?

Using a national sample of practicing marriage and family therapists (MFTs) and their clients, this study investigated whether academic training background is associated with differences in practice patterns and client outcomes. Clinical members of the American Association for Marriage and Family Therapy with academic training in psychology, social work, counseling, and marriage and family therapy were compared on a wide range of clinical practice variables, and their clients were surveyed about their satisfaction and outcomes. Results showed highly similar practice patterns and client outcomes across all four disciplinary groups. Although the findings showed little evidence for the uniqueness of academic marriage and family therapy training among experienced MFTs, they also refute the notion that therapists trained in MFT degree programs practice in unusual or inferior ways compared to MFTs trained originally in other mental health disciplines.

Clinical Competence↗

PubMed1989

Description of adult rolling movements and hypothesis of developmental sequences.

Physical therapists frequently evaluate and teach patients to roll from a supine to a prone position. The purposes of this study were 1) to describe the rolling movements of adults and 2) to determine whether the movement patterns used to roll might represent different developmental steps within three body regions. Thirty-six healthy adult subjects were videotaped during 10 trials of rolling from a supine to a prone position. Written descriptions of each subject's movements were reduced to general categorical descriptions of movement patterns for three body regions (upper extremities, lower extremities, and head and trunk). Stage theory criteria were used in an attempt to order the movement patterns into developmental sequences. The most common combination of movement patterns was used to describe adults' rolling action. Although stage theory criteria were not met, developmental sequences of movement patterns were proposed for the three body regions. Subjects were quite variable in their rolling movements. The most common form of rolling occurred in less than 12% of the subjects' trials. The descriptions of adults' rolling action gathered in this study provide physical therapists with a variety of movement patterns for teaching patients to roll.

Adult↗

PubMed2004

Occupational therapists' reported experiences using weighted vests with children with specific developmental disorders.

The purpose of this study was to identify specific practice patterns of a convenience sample of paediatric occupational therapists and the behavioural changes that they observe when they use weighted vests with children with developmental disorders. Although the practice of weighted vests is accepted clinically, there is little discussion of their use nor is there empirical evidence of their efficacy in the literature. A convenience sample of 51 occupational therapists from different geographic areas of the United States participated in a telephone survey about how they used weighted vests with specific children. This study was a follow-up to a mail survey about paediatric occupational therapists' opinions and general practice patterns with weighted vests. Although the interviewees observed some different behavioural changes in children with various developmental disorders when these children used weighted vests, their practice patterns in using the vests were similar across disabilities. The most common behavioural changes noted were increased attention and staying on task. Participants' opinions and practice patterns related to weighted vests are discussed. This study is not generalizable as it utilized a self-selected group of therapists. However, the findings from the qualitative data can provide direction for future quantitative studies by providing important data about practice patterns that may serve as independent variables examining the effectiveness of weighted vests.

Attention↗

PubMed1993

Affect and outcome in short-term group therapy for loss.

Affect and work variables were monitored for 12 of 16 groups involved in a controlled outcome study of psychoanalytically oriented short-term group therapy. Groups were conducted by experienced therapists for outpatients who experienced difficulties adapting to personal losses through death, separation, or both. Postsessional ratings of positive and negative affect were provided by individual patients, therapists, and other patients. Psychodynamic work was rated independently using a content analysis system. Patients who had experienced separation were more inhibited in their affective expression. Rating sources agreed that positive affect increased over time. Direct relationships were found between positive affect and favorable outcome. Concerning negative affect, the strongest predictors of favorable outcome involved the interaction of affect and work. Implications of these findings are discussed in terms of the cathartic hypothesis.

Adult↗

PubMed2006

Intra- and inter-radiation therapist reproducibility of daily isocenter verification using prostatic fiducial markers.

BACKGROUND: We sought to determine the intra- and inter-radiation therapist reproducibility of a previously established matching technique for daily verification and correction of isocenter position relative to intraprostatic fiducial markers (FM). MATERIALS AND METHODS: With the patient in the treatment position, anterior-posterior and left lateral electronic images are acquired on an amorphous silicon flat panel electronic portal imaging device. After each portal image is acquired, the therapist manually translates and aligns the fiducial markers in the image to the marker contours on the digitally reconstructed radiograph. The distances between the planned and actual isocenter location is displayed. In order to determine the reproducibility of this technique, four therapists repeated and recorded this operation two separate times on 20 previously acquired portal image datasets from two patients. The data were analyzed to obtain the mean variability in the distances measured between and within observers. RESULTS: The mean and median intra-observer variability ranged from 0.4 to 0.7 mm and 0.3 to 0.6 mm respectively with a standard deviation of 0.4 to 1.0 mm. Inter-observer results were similar with a mean variability of 0.9 mm, a median of 0.6 mm, and a standard deviation of 0.7 mm. When using a 5 mm threshold, only 0.5% of treatments will undergo a table shift due to intra or inter-observer error, increasing to an error rate of 2.4% if this threshold were reduced to 3 mm. CONCLUSION: We have found high reproducibility with a previously established method for daily verification and correction of isocenter position relative to prostatic fiducial markers using electronic portal imaging.

Equipment Design↗

PubMed2006

[Present situation of the otorhinolaryngology departments in the Spanish Hospitals. Heterogeneity in handling voice disorders].

The study of voice disorders present some specific difficulties such as the aetiological variability of this kind of disorders or the heterogeneity and the poor data we have about the effectiveness of certain treatments used. Research has performed different types of questionnaires in this area to obtain data about the treatments used in clinical practice. These studies have shown lack or scarce of evaluation and control methods in the rehabilitation programs that the specialists commonly use. In this report, a screening questionnaire was sent to the Otorhinolaryngology Departments of the Spanish Hospitals to obtain information about evaluation and treatment resources in voice pathologies. The results show great variability in clinical voice disorders in Spain. However we can observe a full agreement in the need to systematize this evaluation and the collaboration of the speech-therapists in the treatment of the voice disorders.

Hospitals↗

PubMed1995

Bronchial hygiene therapy.

Bronchial hygiene therapy is useful and effective in the presence of careful patient evaluation, clear definition of therapeutic goals, and application of appropriate modalities. This article defines the variable bronchial hygiene modalities and discusses their indications, contraindications, and applications. Prophylactic and therapeutic bronchial hygiene modalities, diagnostic methods associated with bronchial hygiene therapy, inhaled antibiotic therapy, and therapist driven protocols are also addressed.

Administration, Inhalation↗

PubMed2003

Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists.

BACKGROUND AND PURPOSE: Little research has been done regarding the attitudes and behaviors of physical therapists relative to the use of evidence in practice. The purposes of this study were to describe the beliefs, attitudes, knowledge, and behaviors of physical therapist members of the American Physical Therapy Association (APTA) as they relate to evidence-based practice (EBP) and to generate hypotheses about the relationship between these attributes and personal and practice characteristics of the respondents. METHODS: A survey of a random sample of physical therapist members of APTA resulted in a 48.8% return rate and a sample of 488 that was fairly representative of the national membership. Participants completed a questionnaire designed to determine beliefs, attitudes, knowledge, and behaviors regarding EBP, as well as demographic information about themselves and their practice settings. Responses were summarized for each item, and logistic regression analyses were used to examine relationships among variables. RESULTS: Respondents agreed that the use of evidence in practice was necessary, that the literature was helpful in their practices, and that quality of patient care was better when evidence was used. Training, familiarity with and confidence in search strategies, use of databases, and critical appraisal tended to be associated with younger therapists with fewer years since they were licensed. Seventeen percent of the respondents stated they read fewer than 2 articles in a typical month, and one quarter of the respondents stated they used literature in their clinical decision making less than twice per month. The majority of the respondents had access to online information, although more had access at home than at work. According to the respondents, the primary barrier to implementing EBP was lack of time. DISCUSSION AND CONCLUSION: Physical therapists stated they had a positive attitude about EBP and were interested in learning or improving the skills necessary to implement EBP. They noted that they needed to increase the use of evidence in their daily practice.

Adult↗

PubMed2000

Laser therapy: a randomized, controlled trial of the effects of low intensity Nd:YAG laser irradiation on lateral epicondylitis.

OBJECTIVE: To assess the effectiveness of low intensity laser therapy in the treatment of lateral epicondylitis. DESIGN: A double-masked, placebo-controlled, randomized clinical trial. SETTING: A physical medicine and rehabilitation clinic. PARTICIPANTS: Fifty-two ambulatory men and women (age range, 18-70 yr) with symptomatic lateral epicondylitis of more than 30 days in duration and a normal neurologic examination. INTERVENTION: Subjects were bloc randomized into 2 groups with a computer-generated schedule. All underwent irradiation for 60 seconds at 7 points along the symptomatic forearm 3 times weekly for 4 weeks by a masked therapist. The sole difference between the groups was that the probe of a 1.06-microm continuous wave laser emitted 204 mW/cm2 (12.24 J/cm2) for the treated subjects and was inactive for the control subjects. Subjects were assessed at the beginning, midpoint (session 6), and end (session 12) of treatment, as well as at follow-up 28 to 35 days after their last treatment. MAIN OUTCOME MEASURES: Pain in last 24 hours, tenderness to palpation, and patient's perception of change (benefit). RESULTS: The treated and untreated groups were well matched demographically. Masking was maintained for subjects and therapists; however, the groups did not vary to a statistically significant extent in terms of the main outcome measures either during treatment or at follow-up. Secondary outcome variables, such as grasp and pinch strength, medication use, and pain with grasp and pinch, also failed to statistically differ significantly between the groups. No significant treatment side effects were noted. CONCLUSION: Treatment with low intensity 1.06-microm laser irradiation within the parameters of this study was a safe but ineffective treatment of lateral epicondylitis. Further research seems warranted in this controversial area.

Adolescent↗

PubMed1994

Truth in memory: ramifications for psychotherapy and hypnotherapy.

In this article we address a number of issues relevant to the practice of psychotherapy and hypnotherapy: How reliable is memory? How are therapists' and clients' beliefs and expectancies related to pseudomemory formation? Are certain clients particularly vulnerable to pseudomemory creation? Does hypnosis pose special hazards for pseudomemory reports? What are the variables or factors that mediate hypnotic pseudomemories? In addition to reviewing the literature on these topics, we intend to sensitize the clinician to the potential pitfalls of critical reliance on the patient's memories, as well as uncritically accepted clinical beliefs and practices.

Fantasy↗

PubMed2006

A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function.

BACKGROUND AND PURPOSE: Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. SUBJECTS: The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68-100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10-29). METHODS: A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. RESULTS: The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. DISCUSSION AND CONCLUSION: The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher.

Activities of Daily Living↗

PubMed1984

Mental health concepts of evangelical Protestants.

There has been an upsurge of interest in the problems encountered when attempting counseling and psychotherapy across cultural and ethnic barriers. Differences between therapist and client in nationality, race, and socioeconomic background have been widely discussed. Protestant evangelicals have not received much attention in this literature, yet this group has a world view not likely to be shared by the majority of mental health professionals. To fill this gap, 152 members of liberal and traditional (evangelical, fundamentalist) Protestant churches were investigated. Measures of religious orthodoxy and of modernity served as independent variables. Dependent variables were attitudes toward seeking mental health services, opinions about mental illness, and tendencies to view mental health problems as spiritual. The results indicate that evangelicals are prepared to use professional help, although they are concerned about the beliefs and values of the mental health practitioner and express fears that secular therapists might try to alter their beliefs and values: They prefer to go to religious advisers. They also appear to have certain characteristic ideas about mental illness that need to be addressed in any attempt to counsel such clients.

Attitude to Health↗

PubMed2000

Measurements of temporal aspects of gait obtained with a multimemory stopwatch in persons with gait impairments.

STUDY DESIGN: Repeated measures of 14 temporal factors of gait obtained with a multimemory stopwatch from a variety of subjects with locomotor impairments. OBJECTIVES: To estimate the intratester and intertester reliability of 14 temporal factors of gait by using a multimemory stopwatch; to compare novice and expert clinicians at mastery of making these temporal measurements. BACKGROUND: Temporal gait measures are useful for describing the effectiveness of treatment interventions in patients with locomotor impairments. METHODS AND MEASURES: Eleven adult subjects (mean age, 48.4 years; SD, 5.7 years), 10 with locomotor impairments and 1 elderly adult, ambulated along a 6-m walkway 3 times at a self-selected walking speed. The subjects were videotaped from the side as they walked. Four physical therapists independently analyzed the videotapes on 2 occasions; 2 examiners were recent graduates, and 2 others had 23 years of clinical experience. Intraclass correlation coefficients were used to estimate intratester reliability. A component of variance analysis quantified the sources of variation. RESULTS: Intraclass correlation coefficients for each of the 14 variables varied from 0.88 to 0.98. The major contributor to variance was subject, followed by trial, error, and tester; the tester factor generally contributed less than 1% to the total variance. CONCLUSIONS: Reliable measurements of the temporal aspects of gait can be made by using a multimemory stopwatch and videotape in a clinical setting on patients with various locomotor problems. Our data suggest that measurements obtained by more experienced physical therapists were no more reliable than those made by recent graduates.

Adolescent↗

PubMed1985

Effect of non-surgical periodontal therapy (IV). Operator variability.

Healing following non-surgical periodontal therapy was studied and the results of instrumentation performed by 6 operators compared. Incisors, cuspids and premolars with periodontal pockets up to 11 mm deep in 20 patients were treated by plaque control and a single episode of supra- and subgingival debridement. A split-mouth approach was used to compare the participating therapists. The effects of the therapy were monitored using changes in plaque score, bleeding score, probing pocket depth and probing attachment level. Marked improvement, similar to that seen in previous studies evaluating non-surgical therapy was noted during the initial 6-9 months. No further changes of the recorded parameters could be observed during the rest of the 24-month observation period. Differences between sites treated by the various operators were negligible. Thus, it appears, that deep periodontal pockets in incisors, cuspids and premolars may be successfully treated by plaque control and 1 episode of instrumentation and that operator variability may be limited.

Adult↗

PubMed2005

Benchmarking patient improvement in physical therapy with data envelopment analysis.

PURPOSE: The purpose of this article is to present a case study that documents how management science techniques (in particular data envelopment analysis) can be applied to performance improvement initiatives in an inpatient physical therapy setting. DESIGN/METHODOLOGY/APPROACH: The data used in this study consist of patients referred for inpatient physical therapy following total knee replacement surgery (at a medium-sized medical facility in the Midwestern USA) during the fiscal year 2002. Data envelopment analysis (DEA) was applied to determine the efficiency of treatment, as well as to identify benchmarks for potential patient improvement. Statistical trends in the benchmarking and efficiency results were subsequently analyzed using non-parametric and parametric methods. FINDINGS: Our analysis indicated that the rehabilitation process was largely effective in terms of providing consistent, quality care, as more than half of the patients in our study achieved the maximum amount of rehabilitation possible given available inputs. Among patients that did not achieve maximum results, most could obtain increases in the degree of flexion gain and reductions in the degree of knee extension. RESEARCH LIMITATIONS/IMPLICATIONS: The study is retrospective in nature, and is not based on clinical trial or experimental data. Additionally, DEA results are inherently sensitive to sampling: adding or subtracting individuals from the sample may change the baseline against which efficiency and rehabilitation potential are measured. As such, therapists using this approach must ensure that the sample is representative of the general population, and must not contain significant measurement error. Third, individuals who choose total knee arthroplasty will incur a transient disability. However, this population does not generally fit the World Health Organization International Classification of Functioning, Disability and Health definition of disability if the surgical procedure is successful. Since the study focuses on the outcomes of physical therapy, range of motion measurements and circumferential measurements were chosen as opposed to the more global measures of functional independence such as mobility, transfers and stair climbing. Applying this technique to data on patients with different disabilities (or the same disability with other outcome variables, such as Functional Independence Measure scores) may give dissimilar results. PRACTICAL IMPLICATIONS: This case study provides an example of how one can apply quantitative management science tools in a manner that is both tractable and intuitive to the practising therapist, who may not have an extensive background in quantitative performance improvement or statistics. ORIGINALITY/VALUE: DEA has not been applied to rehabilitation, especially in the case where managers have limited data available.

Arthroplasty, Replacement, Knee↗