HPA The Catalyst · 2018-04-04 · 1.2 million Home Care Aides (HCAs) provide care nationwide to older adults. This job is marked by high rates of strain, turnover, and HCAs report

HPA The Catalyst:Health Policy & Administration

Section

Platform and Poster Presentation Abstract

Combined Sections Meeting

Feb. 21-24, 2018 | New Orleans, LA

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TABLE OF CONTENTS

Platform Presentations……………………………………………………………3-17

Poster Presentations ……………………………………………………………18-56

ABOUT HPA THE CATALYST

MISSION STATEMENTThe mission of the HPA Section

is to transform the culture of physical therapy through

initiatives that enhance professionalism, leadership,

management, and advocacy to foster excellence in autonomous

practice for the benefit of members and society.

Visit us at APTAHPA.org

VISION STATEMENTBy 2020, HPA The Catalyst will

be the expert in integrating professionalism into the culture

of physical therapy:We will be sought by healthcare professionals, APTA components, and decision makers to influence

social, political, and economic policies that impact physical therapy

and health.

We will have created and delivered programs that develop professionals, leaders, managers, and advocates to foster excellence in physical therapy.

We will be leaders in promoting cultural competence, global health

initiatives, social responsibility, effective application of technology,

and health services research.

ABOUT USA catalyst is a person or thing that precipitates change or a

substance that accelerates action We are a professional association

serving member physical therapists, physical therapist

assistants, and physical therapy students.

We provide a community for professionals to advance the

health and wellbeing of society through innovation, leadership and professionalism in physical

therapy. HPA members practice in a variety of professional settings performing many different roles.

Members work with patients across the entire lifespan and

continuum of care.

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PLATFORM PRESENTATIONS

A Novel Physical Therapist-led Worksite Wellness Program for Home Care AidesPRESENTED BYMargaret Danilovich, PT, DPT, PhD, GCS

PURPOSE1.2 million Home Care Aides (HCAs) provide care nationwide to older adults. This job is marked by high rates of strain, turnover, and HCAs report a lack of training impacting work making physical therapists (PTs) uniquely positioned to lead health promotion efforts within this profession. The purpose of this study is to report a first-of-its-kind approach to integrating PTs within a Medicaid worksite wellness program. We used a community-engaged approach to develop the intervention and then randomized HCAs into control, Fitbit, motivational text messages, or Fitbit and text message groups to evaluate the 12-week program.

DESCRIPTIONWe used a community-engaged approach with HCA stakeholders. Grounded in the Health Action Process Approach theory, we focused on mechanisms to build self-efficacy and strategies to bridge the intention-behavior gap. Stakeholders reviewed researcher-developed motivational text messages to refine content for HCAs. The program met on a Saturday every 6 weeks for 3 months. Sessions included a health lecture (nutrition, physical activity, and body mechanics) and exercise class (yoga, Zumba, and Tai Chi). Participants set personal health goals, signed behavioral contracts, and received a Fitbit and exercise resources in their home neighborhood.We enrolled n=31 participants (mean age 53 years ± 13.0; BMI = 32.6 ± 8.1; Blood pressure = 135/81 ± 16.1/12.0 mmHg; PROMIS physical = 13.9 ± 3.2; PROMIS mental = 13.9 ± 3.3; Self-efficacy for Exercise = 6.5 ±2.5; Perceived Stress Sale = 15.6 ± 7.4; and average steps/day = 9,977 ± 9,940).

SUMMARY OF USEWe recruited 33 HCAs of whom 13 enrolled. Later, the agency withdrew from our partnership because of agency restructuring. We then partnered with other agencies for recruitment. Of the enrolled 31 HCAs, 5 completed all 3 sessions and 17 completed 2 sessions. We did not offer a financial incentive to HCAs beyond the Fitbit which may account for recruitment difficulties and high attrition rates. Other challenges included HCAs not owning technology to download or access Fitbit app/website and not having Wifi at home to sync data. Mean program satisfaction rate was 9.3/10. HCAs reported benefits including “understanding what triggers my motivation” and improved energy. Health education increased “awareness of health concerns”. HCAs improved client care due to recognizing the need to “take better care of myself so that I can take better care of her.”

IMPORTANCE TO MEMBERSDespite challenges, HCA agencies present a unique opportunity for PTs to partner in health and wellness promotion. Developing a collaborative relationship with agency partners to best understand agency operations will facilitate optimal implementation. Health measurements show significant issues with obesity, hypertension, and physical inactivity that warrants continued efforts to reach this underserved population.

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Functional Status is Associated with 30-day Potentially Preventable Hospital Readmissions following Inpatient Rehabilitation among Aged Medicare Fee-for-Service Beneficiaries PRESENTED BYAddie Middleton

PURPOSE/HYPOTHESISTo determine the association between patients’ functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions.

NUMBER OF SUBJECTSNational cohort of 371,846 inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013-2014. The average age was 79.1 (SD, 7.6) years. A majority were female (59.7%) and non-Hispanic white (84.5%).

MATERIALS/METHODSWe calculated observed rates and corresponding 95% confidence intervals (CI) of 30-day potentially preventable readmissions for the overall sample and by patient characteristic. We used multilevel logistic regression to examine the association between patients’ functional status at discharge from inpatient rehabilitation and 30-day potentially preventable readmissions. Due to multicollinearity between self-care and mobility scores, we estimated separate models for each with cognition scores and the following covariates: age; sex; race/ethnicity; disability entitlement; dual eligibility; number of hospitalizations over prior six months; number of comorbidities; index hospitalization diagnostic category, length of stay, and ICU/CCU utilization; and inpatient rehabilitation admission impairment group, program interruption, and bowel/bladder management score. We categorized performance on the functional domains into lowest quartile, interquartile range, and highest quartile for analyses. We also extracted information on the primary diagnoses for readmissions.

RESULTSThe overall rate of any 30-day hospital readmission following inpatient rehabilitation was 12.4% (N=46,265) and the overall rate of potentially preventable readmissions was 5.0% (N=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates (95% CI) for the highest vs. lowest quartiles within each functional domain were as follows: self-care: 3.4% (3.3-3.5) vs 6.9% (6.7-7.1); mobility: 3.3% (3.2-3.4) vs 7.2% (7.0-7.4); cognition 3.5% (3.4-3.6) vs 6.2% (6.0-6.4). Similarly, adjusted odds ratios were as follows: self-care: 0.70 (0.67-0.74); mobility: 0.64 (0.61-0.68); cognition: 0.84 (0.80-0.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%).

CONCLUSIONSFunctional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries.

CLINICAL RELEVANCEThe methodological approach used in this study indicates physical therapists may use epidemiological methods to support the rationale and track outcomes associated with population-based health programs.

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Telerehabilitation utilization within the Veterans Administration healthcare system over the past 6 years. PRESENTED BYAngela MacCabe, PT, DPT

PURPOSE/HYPOTHESISThe retrospective study examined national telerehabilitation utilization among US veterans in the VA Health Care System (VAHCS). Data for telehealth sessions of speech language pathology (SLP), physical (PT) and occupational therapy (OT) were examined and compared to traditional rehabilitation. The purpose was to examine the trends of telerehabilitation utilization in the VAHCS over the past six years.

NUMBER OF SUBJECTSThe number of overall patient encounters in the VAHCS from October 1, 2009 to September 30, 2015 was 13,266,017 encounters. Telerehabilitation accounted for a total 45,128 total visits or 0.34% of overall patient encounters within the VAHCS.

MATERIALS/METHODSRetrospective data were extracted from the VA’s web-based analysis program (Pyramid Analytics) and exported into Microsoft Excel. Data included total patient encounters, discipline, site location, visit year, and diagnosis, in the lookback period of October 1, 2009 to September 30, 2015 or fiscal year (FY) 2010 to 2015. Pivot tables were utilized to extrapolate data. For comparison purposes, national data were further broken down into five geographic regions: West, Southwest, Midwest, Southeast, and Northeast.

RESULTSTelerehabilitation accounted for an increasing percentage of total VAHCS encounters over the lookback period; starting at 0.20% of total patient encounters in FY 2010 and increasing to 0.68% in FY 2015. PT accounted for the majority of telerehabilitation encounters (47.58%), followed by SLP (37.14%) and OT (15.28%). Regionally, the Northeast had the most telerehabilitation utilization (41.73%) followed by the Southeast (18.07%), West (17.16%), Midwest (13.21%) and Southwest (9.83%). Telerehabilitation was utilized most by PT in the Northeast, Southeast and Southwest. SLP telerehabilitation was the most utilized in the West and Midwest. OT was the least utilized in all regions, with the exception of the West. The most frequently documented diagnosis ICD-9 descriptions for PT and OT were “Influencing Health Status and Contact with Health Services” and “Diseases of the Musculoskeletal System/Connective Tissue.” For SLP, “Symptoms, Signs, and Ill-Defined Conditions” and “Influencing Health Status and Contact with Health Services” were the two most reported descriptions.

CONCLUSIONSTelerehabilitation accounted for a minute percentage of the VAHCS therapy encounters; a general uptrend was demonstrated over the last six years. PT consistently demonstrated the most usage of the disciplines, followed by SLP and OT. The variety of ICD-9 codes reported for telerehabilitation encounters demonstrated this mode of service may be useful for a diverse range of diagnoses.

CLINICAL RELEVANCETelerehabilitation mode of delivery for therapy services is minimal despite the significant telehealth resources within the VAHCS. Further research is needed to explore outcomes, patient satisfaction, cost benefits, and application of new technology. Telerehabilitation research could be continued outside the VAHCS to observe civilian utilization.

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A spatial analysis of disparities in access to physical therapy services in the Denver metro region using mapping technology PRESENTED BYCorey Rovzar, PhD

PURPOSE/HYPOTHESISAcross the United States, geographic barriers to healthcare access have resulted in socioeconomic disparities in various health outcomes. Much of the research in this area has focused on access to medical services, and little is known about access to rehabilitation services . The purpose of this study is to evaluate the location of outpatient physical therapy services relative to the socioeconomic characteristics of Denver, CO as a means of identifying those areas with limited accessibility.

NUMBER OF SUBJECTSNone.

MATERIALS/METHODSSocioeconomic data were collected from the US Census Bureau which provides information at the census tract level from the last census completed in 2010 to characterize poverty levels, education levels, minority population composition, and uninsured rates across the Denver region. 359 businesses and hospitals with out-patient physical therapy services were identified through the Colorado Department of Regulatory Agencies and the Colorado Department of Public Health and Environment, respectively. The Geographic Information System (GIS), ArcGIS , was used to spatially analyze the location of physical therapy services and delineate coverage within a 1 mile radius of each physical therapy location.

RESULTSSpatial analysis identified Aurora, the third largest city in Colorado, as a location within the Denver regional area with relatively low access to out-patient physical therapy services. Aurora’s poverty level is 20% higher than the regional average; the percentage of adults with a bachelor’s degree is 33% lower than the regional average; racial and ethnic minorities comprise 37% of Aurora’s population (compared to 30% for the region); and the percentage of uninsured individuals is 6% lower than the regional average. Furthermore, in the city of Aurora, there is one clinic for every 22, 069 individuals whereas in the city of Denver there is one clinic for every 8, 403 individuals. In addition, 16% of the total area of Aurora falls within 1 mile of a physical therapy clinic in contrast to Denver which has 42% coverage.

CONCLUSIONSOur study is the first to use ArcGIS technology to identify discrepancies in the accessibility of physical therapy services in relation to socioeconomic and demographic data. Results from this study suggest that the distribution of outpatient physical therapy services throughout the Denver regional area is not equitable across the variable socioeconomic landscape of the region.

CLINICAL RELEVANCEGIS can be used to identify locations with poor physical therapy access and potentially poor health outcomes as well as analyze socioeconomic factors associated with barriers to access. Further, this methodology can inform the expansion of physical therapy services into traditionally underserved areas through hospital based services or pro-bono clinics.

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Evaluating the Utilization of Physical Therapy and Spinal Surgery among Older Adults with Lumbar Spinal Stenosis PRESENTED BYCatherine Schmidt, PT, DPT, MS,PhD

PURPOSE/HYPOTHESISMedicare spending for health care associated with spinal surgeries in patients with lumbar spinal stenosis (LSS) has more than doubled from 1992-2003, with costs associated with spinal fusion surgery increasing from $75 million to $482 million. Limited evidence suggests that physical therapy (PT) reduces the likelihood of progression to surgery and offers comparable benefits in terms of pain relief, function and disability outcomes. While the rates of (PT) combined with other modes of conservative therapy have been studied, the rates of physical therapy alone have not been studied among patients with LSS. Research is needed to describe the utilization of physical therapy and to understand its impact on the probability of delaying or preventing surgery and minimizing use of healthcare resources following initial diagnosis. The purposes of this research are to: (1) compare the rates of PT and spinal surgery up to 2 years; and (2) describe the timing of episodes of PT and spinal surgery following incident diagnosis of lumbar spinal stenosis. Our main hypothesis is that a greater proportion of beneficiaries will utilize PT services over surgery and will do so within 30 days following initial diagnosis of LSS.

NUMBER OF SUBJECTSNone.

MATERIALS/METHODSThis study was a retrospective analysis of claims data from a 20% random sample of Medicare Part B beneficiaries with a new diagnosis of LSS during 2008. Beneficiaries aged 65 years and older with a new diagnosis of LSS during 2008 were identified using ICD-9-CM codes. A look-back period was used to identify and exclude beneficiaries with the diagnosis of LSS during 2007. Episodes of PT and spinal surgery were abstracted from claims data using Current Procedural Terminology (CPT) codes.

RESULTSA greater proportion of Medicare beneficiaries with a new diagnosis of LSS in 2008 received PT compared to spinal surgery during the two years following incident diagnosis of LSS. The greatest proportion of beneficiaries received 1-2 episodes of PT while those having surgery underwent a single surgical procedure during the two years. The greatest proportion of beneficiaries received their first episode of PT up to 25 days and spinal surgery up to 90 days following initial diagnosis.

CONCLUSIONSFindings from this study are consistent with our hypothesis that a greater proportion of beneficiaries utilize PT over surgery during two years following initial diagnosis of LSS. Furthermore, PT services are utilized within 25 days of diagnosis. Our sample was limited to a 20% random sample of Medicare Part B beneficiaries and may not be fully representative of all Medicare beneficiaries.

CLINICAL RELEVANCEThis study provides preliminary and descriptive information about the rates of PT and spinal surgery following incident diagnosis of LSS. Findings from this study can be used to directly inform future analyses evaluating the impact of physical therapy on delaying spinal surgery among patients with LSS.

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Technology to track adherence: Smartwatches can detect walker and cane use in older adults at a high risk of falls PRESENTED BYStephen Antos, PT, DPT

PURPOSE/HYPOTHESISTo reduce the risk of falling, physical therapists commonly prescribe assistive devices such as walkers or canes.1,2 However, assistive devices may not be used as often as prescribed.3 Physical therapists rely on patient self-report to determine assistive device adherence. Smartphones and smartwatches have sensors that capture movements and enable computer algorithms to detect differences in physical activity.4,5 Because an individual’s movement can change while using a walker or cane,6 we hypothesized that smartphones or watches can detect whether an older adult is using their assistive device.

NUMBER OF SUBJECTS9

MATERIALS/METHODSWe recruited nine community dwelling older adults receiving adult day center services (6M, mean age 78.3 ± 9.1 SD, Berg Balance Score 39.8 ± 6.0, Mini-Mental State Exam 23.0 ± 6.5). Each participant completed the following outcome measures on five separate days with and without their assistive device: 6 Minute Walk Test, 10 Meter Walk Test, and Timed Up and Go. We used onboard sensor data from the smartphone and smartwatch to train machine learning algorithms to detect whether the participant was walking with their walker or cane. We then tested the reliability of our detection algorithms by using across-day cross-validation for each participant.

RESULTSWhen using smartwatch sensors, we were able to detect whether a participant was using their walker or cane with greater than 98% accuracy across days. Notably, our algorithms were trained with data collected during common physical therapy outcome measures, and maintained high detection accuracy with only a single day of training for all participants. However, when using smartphone sensors, we were unable to reliably detect walker or cane use across days, with accuracies close to chance (50%) for all but one subject (where we achieved 96% accuracy).

CONCLUSIONSSmartwatches offer a robust platform to detect whether an older adult is walking with their walker or cane. Smartphones may perform well in individuals with pronounced gait deviations, but are unreliable for most individuals.

CLINICAL RELEVANCESmartphones and smartwatches are available to both physical therapists and the general public, making them powerful and scalable tools to understand and monitor patient mobility. Our findings show the potential of these technologies to augment traditional physical therapy practice by providing clinically useful, objective measurements of assistive device adherence. Such information can enable timely interventions such as education, proper device fitting, or further training prior to a fall occurring.

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Come Out From Behind the Walls: A Church-Based Walking Program to Increase Physical Activity in Chicago’s Austin Community PRESENTED BYWilliam Healey, PT, EdD, GCS

PURPOSE/HYPOTHESISRacial health disparities have a significant impact on quality of life, especially in Chicago’s Austin community, which is 85% African American. Low levels of physical activity (PA) contribute to poor health outcomes especially in older adults. Our aim was to examine the effects of church-based community health workers (CHWs) on PA among urban African-American adults through the use of social media.

NUMBER OF SUBJECTSOur community partner recruited 67 African Americans from 10 Austin churches; 79% were female, average age 50 years.

MATERIALS/METHODSFourteen church-based groups were led by a “Walking Champion” (CHW) for this 9-week program. Each CHW invited church members to participate. CHWs were trained by the research team and provided with a health and wellness (H&W) manual. Groups were encouraged to walk together at least once per week and post on a private Facebook® page. Each participant received a Fitbit® activity tracker to record daily steps. During each week’s group walk, the CHW led a discussion based on the H&W information. Each CHW was contacted weekly via telephone call, text messaging, or email by a student partner to discuss the progress of their walking group. Data was collected at baseline and at the end of 9 weeks. Outcomes included physiologic measures (weight, height, heart rate and blood pressure) and self-reported data from the Short-Form Health Survey, Self-Efficacy for Exercise Questionnaire (SEEQ), Survey of Social Cohesiveness, and Global Physical Activity Questionnaire. Daily steps were recorded using the Fitbit® and Facebook® group posts were counted weekly.

RESULTSOf the 67 participants who began the study, 62 (92.54%) were reported by the CHWs as weekly walkers. Fifty-one participants (76%) returned for final measurements. Of the final sample, 29 (57%) were Austin residents and 22 (43%) lived in other Chicago neighborhoods. Statistically significant changes were seen in diastolic blood pressure between pre- and post-intervention (p= 0.018) and SEEQ scores between pre- and post-intervention (p=0.004). Average daily steps between weeks 4 and 9 also increased and reached statistical significance (p=0.016).

CONCLUSIONSPrograms such as “Come out from Behind the Walls” demonstrate that the use of church-based CHWs, Fitbits® and social media may increase PA and reduce diastolic blood pressure. This study also indicates that utilizing faith-based organizations augments recruitment and retention in African-American communities. Future research should investigate 1) the length, intensity and time of year of walking programs; 2) including other pre-existing social groups; and 3) other social media strategies or using text, email or phone calls to enhance PA.

CLINICAL RELEVANCEAs exercise and movement specialists, physical therapists have a duty to use their expertise to improve community health and fitness, improve health equity, and demonstrate social responsibility.

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Predictors of Persistently High Cost Healthcare Utilization for Musculoskeletal Pain PRESENTED BYTrevor Lentz, PT

PURPOSE/HYPOTHESISThe aim of this study was to identify factors that predict persistent high cost healthcare utilization associated with musculoskeletal pain.

NUMBER OF SUBJECTS12,985 survey respondents with a musculoskeletal pain diagnosis, representing 150,792,697 individuals in the US population (weighted).

MATERIALS/METHODSThis study used Public Use File Household Component data from the Medical Expenditure Panel Survey (MEPS) (Panels 13-17, years 2008-2013). Respondents with musculoskeletal pain conditions were identified using established ICD-9 codes. Annual pain-related healthcare expenditure summaries were constructed. Respondents in the top or bottom 15% of expenditures over 2 years were defined as the HIGH and LOW expenditure group, respectively. Predictors were collected from Year 1 and included sociodemographic and work-related variables, comorbidities, psychological distress, self-reported function, pain interference, and health-related variables. Multivariate logistic regression determined predictors of HIGH (top 15% in both years) or MEDIUM (middle 70% both years) group membership compared to the reference group (LOW - bottom 15% both years).

RESULTSThose with HIGH expenditures represented 4% of respondents with a musculoskeletal pain diagnosis. Variables consistently associated with increased odds of higher expenditure group membership were (range of odds ratio point estimates, all p<.05): older age (1.01-1.02), greater missed work days (1.58-2.61), greater pain interference (1.34-1.60), having private insurance (1.41-2.71), having a musculoskeletal injury diagnosis (1.49-1.64), greater number of musculoskeletal diagnoses (1.59-3.12), and greater use of prescription pain medication (1.17-1.38). Variables associated with consistently decreased odds of higher expenditure group membership were being black (0.58-0.72) and having low income compared to being poor/near poor (0.48-0.70).

CONCLUSIONSPersistent high cost utilization across two years is concentrated among older adults with private insurance who have a greater number of comorbid musculoskeletal pain conditions and more disabling pain. The majority of those that experience initial high cost episodes do not continue to have high expenditures over time. Use of prescription pain medication predicted utilization persistence independent of pain interference, highlighting the potential for medication use to contribute to high downstream costs. The general psychological distress measures used in this study did not predict persistence of high cost utilization when considered alongside other pain-related variables.

CLINICAL RELEVANCEClinical Relevance: Those with persistently high cost utilization are a research priority because of their unique ability to identify potential system inefficiencies linked to low-value care. Clinical outcomes and costs of different treatment pathways should be compared to identify ways of improving value for those at risk for persistent high cost utilization due to musculoskeletal pain.

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The Influence of a Co-Located Physical Therapist in Primary Care Medical Home on Opioid Prescriptions and Emergency Department Visits. PRESENTED BYMarissa Carvalho, PT, DPT, OCS, TPS

PURPOSE/HYPOTHESISThe purpose of this study was to examine co-located physical therapy (PT) onsite in a Primary Care Medical Home (PCMH) versus referral for PT evaluation offsite for patients with a chief musculoskeletal (MSK) complaint for outcomes of 12-month opioid use and emergency department (ED) visits.

NUMBER OF SUBJECTS465

MATERIALS/METHODSPatients were seen in one PCMH of an academic center seeking care for a chief MSK complaint from April 2015 to April 2016. We compared 12-month opioid and ED use for patients with a primary care provider (PCP) appointment for a MSK complaint and referred for onsite co-located PT evaluation versus PT evaluation offsite. Analyses of differences were conducted with chi-square tests of proportions. Outcomes were modeled by logistic regression in unadjusted, adjusted and matched models. Inverse probability weighting was used to match sociodemographic, clinical and health service characteristics between patients seeking care onsite versus offsite. Odds ratios and 95% confidence intervals were the measure of association and variability.

RESULTSOf 5,370 PCMH patients, one quarter (n=1,445, 27%) had a PCP encounter for a chief complaint of MSK pain. Of those, 32% were evaluated by PT (n=256 onsite,n=209 offsite). Opioid prescriptions were lower for patients seen by PT onsite than PT offsite (64% vs 76%, p<0.01). There was a 44% lower unadjusted odds of opioid prescription for patients seen by PT onsite versus offsite (OR=0.56, 95%CI 0.37-0.48). After adjusting for patient characteristics, the association was no longer significant (adjusted OR=0.72, 95%CI 0.45, 1.15; matched OR=0.66, 95% CI 0.42,1.03). MSK-related ED visits in the same year also differed between groups (8.6% PT onsite vs 18.2% PT offsite,p<0.01). Patients evaluated by PT onsite were half as likely as PT offsite to have an MSK-related ED visit (unadjusted OR=0.42, 95%CI 0.24,0.74; adjusted OR=0.52, 95% CI 0.28, 0.95; matched OR=0.41 95% CI 0.23,0.72).

CONCLUSIONSED visits and opioid prescriptions were lower among patients receiving onsite PT within the PCMH with a chief MSK complaint compared to offsite referral to PT.

CLINICAL RELEVANCEMore than 50% of the US population reports MSK conditions with the direct related cost of lost workdays equating to 5.2% of the GDP—$796.3 billion—annually.1 Although clinical guidelines recommend PT as front-line care for MSK conditions, referrals to PT for evaluation and management are disproportionate to the number in need and uptake of these clinical guidelines is slow.2,3 ED visits and opioid prescriptions for MSK pain are common in the US.2,4,5 There was a 142% increase in the number of prescription medications filled by people with MSK conditions from 2009-20111 and ED visits are as high as 2.6 million for back pain alone.5 Our study finds that close proximity of PT services within the PCMH impacts opioid prescriptions and ED visits for patients with MSK complaints. PT’s co-located or integrated into the PCMH could play a pivotal role in decreasing morbidity and the rising costs of MSK care.

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Outpatient Physical Therapy Presence and Access in Medically Underserved Chicago Communities PRESENTED BYWilliam Healey, PT, EdD, GCS

PURPOSE/HYPOTHESISThis report describes the innovative and alternative use of geographic information systems (GIS) with publically-available data to examine the presence of outpatient physical therapy (PT) services in medically underserved Chicago communities.

DESCRIPTIONLevels of morbidity and mortality in the U.S. continue to be reported as higher among racial and ethnic minorities than among the White population, suggesting a likely higher demand for PT services. Similar trends of racial/ethnic health disparities that exist at the national level are also reflected in the City of Chicago. The majority of neighborhoods identified as medically underserved in Chicago are predominantly African American and Hispanic. The designated medically underserved areas receive safety net services that include free or Medicaid primary medical care, behavioral health and oral care. There is limited/no mention of PT services offered by safety net health facilities. Unpublished studies of PT presence in Chicago reported low or no outpatient PT services in several predominately African American neighborhoods.

SUMMARY OF USEAccessibility to outpatient PT services in six selected Chicago communities was examined using GIS geospatial analysis techniques. GISs are collections of hardware, software, data, and methods for visualizing, managing, and analyzing all types of geographically referenced data. ArcGIS® software and U.S. Census Bureau, City of Chicago Data Portal, and publically-available PT websites were used to map features of the communities. Three communities were selected by racial/ethnic make-up, population and high hardship index (HI). The HI is scored based on six socioeconomic factors found relevant to public health. Adjacent communities with low HI were then identified. GIS was analyzed in each area to identify: 1) the distribution of outpatient PT providers; 2) travel times of community residents to access PT services; and 3) transportation routes. To augment the GIS mapping, two focus groups were held and gathered additional African American or Hispanic community stakeholder input on PT presence and access in their communities. The three high HI communities were African American or Hispanic and had only one hospital-based outpatient PT provider in each neighborhood. The three neighborhoods adjacent to these communities were mostly White and had multiple hospital-based and freestanding outpatient PT clinics for residents to access. Focus group participants reported barriers to PT access were a need to travel outside their community, time, financial limitations, and a lack of awareness of PT benefits.

IMPORTANCE TO MEMBERSThis is the first known report using GIS to describe distribution of outpatient PT services for an urban community in the United States. This report found a lack of outpatient PT providers in several densely-populated, predominately African American and Hispanic Chicago communities. Lack of access to outpatient PT may impact the health and well being of these community residents, who must leave their neighborhoods to receive PT care.

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Improving Access to Physical Therapy and Reducing Missed Evaluations Using Predictive PRESENTED BYLucas VanEtten, PT, DPT, OCS

PURPOSE/HYPOTHESISPatient cancelations and no-shows can substantially impact other patient’s outcomes, timely access to physical therapy services, clinical efficiency, and clinic finances. Factors predicting patient attendance to critical care clinics (e.g. diabetic management clinics) have been reported, however literature predicting patient attendance in outpatient PT is limited. The purpose of this project was to identify factors which may impact cancellation and no show rates for PT evaluations.

NUMBER OF SUBJECTS13,906 outpatient PT evaluations scheduled from January 2011-May 2016

MATERIALS/METHODSA retrospective data pull was performed of demographic data on PT evaluations scheduled at a large academic health care system. A binary logistic regression model was fitted to the data to evaluate changes in odds of attendance to the physical therapy initial evaluation. Multiple demographic variables were analyzed, and factors were added to the model if a trend appeared in the data that was statistically significant using a chi-squared test (a significance level of p <.05 was set a priori). The coefficients were then exponentiated to convert them to report the change in odds of keeping the appointment based on a single unit change in the predictor variable.

RESULTSThe following factors were identified as altering odds of a patient maintaining an initial PT appointment (β, standard error, p value): Days to scheduled appointment (-.072, .003, p<.001), post-operative (-.196, .038, p<.001), age>50 (.328, .043, p<.001), unemployed (-.508,.050, p<.001), part-time employment (-.198, .086, p<.05), and new patient to the system (-1.317, .178, p<.001).

CONCLUSIONSConversion of the above data yielded changes in the odds ratio for each factor in the following fashion: for each additional day between contact and the scheduled appointment decreased the odds of completing the appointment by 7%; post-operative appointment decreased the odds of completion by 18%; age greater than 50 increased the odds of attendance by 39%; unemployed status decreased the odds of attendance by 40%; part-time employment decreased the odds by 18%; and new patients to the system decreased the odds by 131%.

CLINICAL RELEVANCEPatient attendance to the initial PT evaluation may be modified or improved by minimizing the number of days between initial contact and the initial PT appointment. Recognizing factors which may predict patient attendance to PT evaluations may improve access to PT services, clinical efficiency, and resource loss from missed opportunities to evaluate and treat patients. Efforts must be made to optimize access to PT services and scheduling to improve the odds of patients attending their first PT appointment. Future research is necessary to validate this model, evaluate the generalizability of these factors to other settings, and evaluate how these factors may be modified to improve the odds of attending the first PT appointment.

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An Interprofessional Collaborative Workforce Analysis of Hand Therapy Services within United States Population CharacteristicsPRESENTED BYCaroline W Stegink-Jansen

BACKGROUND AND PURPOSEHand therapy is a specialization that is a confluence of Occupational (OT) and Physical Therapy (PT) practice skills and professionals. Work force planning is needed for hand therapy services as PT and OT workforce analyses do not provide information about this workforce. This descriptive study by an interprofessional team of researchers, aimed to map the geographical distribution of US Certified Hand Therapists (CHT) in context of characteristics of US populations.

CASE DESCRIPTIONA collaborative team was formed to bring the skills together needed for this project. Contacts were established with the leadership of the Hand Therapy Certification Commission (HTCC), the American Society of Hand Therapists, the APTA and AOTA. Methods: A de-identified Zip Code list of all active CHTs (6,151) through April 2016 provided by the HTCC was used, resulting in 5572 CHTs with ZIP codes and US Census Zip Code Tabulation Areas (ZCTA). The demographics were: 87.6% OTs, 0.05% both OT and PT), and 11.8% PTs, 58.5% female, 12.2% male and 29.3% did not report gender. Ages ranged from 27 to 86 years old (median 49). The CHT ZCTAs were matched with the census parameters “rurality”, “poverty” and “race and ethnicity” from the 2010 US Census and 2014 American Community Survey. A Geo Information System (GIS) (ArcMap 10.31. [Esri, 2015 Redlands, CA]) was used for mapping and analysis. The output/results consisted of descriptive maps and statistics.

OUTCOMESJust 9% of the total number of 33,120 US ZCTAs had CHTs present. CHTs practice areas mostly overlapped with high density US population areas. The population in CHT ZCTAs was 1) urban in nature, 2) with lower poverty rates than ZCTAs without CHTs, and 3) mostly reflecting US race and ethnicity population distribution, with a slightly higher percent of Whites. Most CHTs (67%), worked in concentrations of one to three CHTs per ZCTA, contributing to a larger geographic spread of CHT availability than expected. Only 3.7% of CHTs worked in large centers with 11 to 26 CHTs per ZCTA near or in urban centers.

DISCUSSIONSUMMARY OF USE: This study supports the need interprofessional collaboration. The findings provide a foundational snap shot of the distribution and potential availability of the current CHT workforce in the context of US population characteristics. IMPORTANCE FOR MEMBERS: PTs are underrepresented within the CHT community. This descriptive study provides can inform planning to optimally grow the CHT profession to meet population needs.

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PLATFORM PRESENTAITONS

Effectiveness of Physical Therapy Clinician Response to Inappropriate Patient Sexual Behavior: Results of a National Survey PRESENTED BYJill Boissonnault, PT, PhD, WCS

PURPOSE/HYPOTHESISTo determine how clinicians attempt to address inappropriate patient sexual behavior (IPSB) and examine strategy effectiveness in resolving the behaviors.

NUMBER OF SUBJECTS849 respondents provided data for this analysis. PTs, PT students, PTAs and PTA students were eligible participants and were recruited as a convenience sample through selected PT and PTA academic programs as well as through APTA sections.

MATERIALS/METHODSSurvey content validity and test-retest reliability were established.The survey consisted of demographics, IPSB experience, and clinician responses/perceived effects sections. The responses section asked what responses practitioners used and how those responses impacted the behaviors. Data were analyzed qualitatively and quantitatively and further analyzed for effect of gender, years of experience, professional status, and working with cognitively impaired patients.

RESULTSPT practitioners under age 40 were more likely to ignore IPSB, while practitioners over 40 tended to directly confront patients. Similarly, students and clinicians with ten years’ experience or less were more likely to both ignore behavior and joke with patients, while clinicians with greater than 10 years experience are more likely to speak directly with their patients. Female PTs were more likely to document IPSB than their male counterparts and only women filed lawsuits or called police.Distracting or redirecting the behavior, avoiding the behavior, and directly confronting the behavior were the most effective informal responses to IPSB. Joking about the behavior with the patient and ignoring the situation were least likely to improve the situation and most likely to worsen the situation. Use of a behavioral contract was significantly more effective than any other formal action. Other formal actions that were effective for the majority that used them included using chaperones and transferring or terminating care of the patient. No differences were found in reported effetiveness of actions when analyzed by gender of respondents.

CONCLUSIONSEffective clinician responses to IPSB include informal responses such as avoiding the behavior and directly confronting it, as well as formal responses such as using behavioral contracts or chaperones, and transferring or terminating care. Older and more experienced clinicians were more likely to use effective strategies than students or younger, novice clinicians.

CLINICAL RELEVANCEIPSB is prevalent in physical therapy as evidenced by previous analysis of this survey data where 84.2% of respondents indicated exposure to IPSB throughout their career and 46.6% reported exposure to IPSB within the last 12 months. Understanding typical responses to IPSB as well as perception of the effect of these responses may assist educators, administrators and policy makers in determining strategies to combat the phenomenon and how best to protect and support clinicians.

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Impact of Personal Exposure to Persons with Substance Use Disorders on Physical Therapy Practice PRESENTED BYRania Karim, DPT, GCS, CEEAA

PURPOSE/HYPOTHESISThe purpose of this study was to examine the impact of personal exposure to individuals with substance use disorders (SUDs) on two areas of clinical practice: comfort level in addressing substance use and physical therapy clinicians’ perceived susceptibility of encountering such situations. We hypothesized that individuals, who report knowing someone who has struggled with addiction, are more likely to experience greater levels of comfort in discussing substance use and to perceive increased susceptibility of encountering patients with SUDs.

NUMBER OF SUBJECTS234 PTs and PTAs completed the survey.

MATERIALS/METHODSMarshall University (MU) Physical Therapy faculty along with MU addiction education staff developed a 25-question, 103-item survey based on the Health Belief Model. This research received approval from MU IRB to collect a convenience sample of PTs and PTAs through message boards, list-serves, and alumni connections. Multiple one-sample chi-squared tests were used to assess associations between “personal exposure to individuals with SUDs” (i.e. knowing someone who has struggled with addiction) and “comfort level in addressing three aspects of substance use (alcohol consumption, illicit drug use and prescription drug use)”, and associations between “personal exposure to individuals with SUDs” and “clinician’s perceived susceptibility in encountering patients with seven substance abuse situations (alcoholism, addiction withdrawals, prescription drug abuse, illicit drug abuse, accidents related to addiction, and addiction developed during the course of physical therapy).”

RESULTS170 (72.6%) respondents had personal exposure to individuals with SUDs. Personal exposure to individuals with SUDs was significantly associated with comfort level in addressing all three aspects of substance use: alcohol consumption (Χ2 = 21.403, p =.000), illicit drug use (Χ2 = 16.004, p =.000), and prescription drug use (Χ2 = 20.905, p =.000). Significant associations between perceived susceptibility and personal exposure were not found, except in the context of illicit drug abuse (Χ2=20.905, p=.005) and addiction history (Χ2=14.395, p=.001).

CONCLUSIONSPTs/PTAs with personal exposure to individuals with SUDs were more likely to report higher levels of comfort discussing substance abuse with their patients. However, perceived susceptibility lacked clear association with personal exposure in the majority of categories examined.

CLINICAL RELEVANCESubstance abuse is a pervasive public health problem. Patients referred to physical therapy may be at greater risk for developing SUDs due to pain, activity limitations, participation restrictions and subsequent adverse contextual factors, which can further result in maladaptive coping mechanisms. Examining PTs/PTAs health beliefs on SUDs is essential for facilitating behavior change towards further adoption of universal screening.

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PLATFORM PRESENTATION

Individualization Counts: Physical Activity Preferences of Older Adult Medicaid Home and Community Based Services Waiver Clients PRESENTED BYMargaret Danilovich, PT, DPT, PhD, GCS

PURPOSE/HYPOTHESISPhysical activity (PA) is not currently offered to older adult clients receiving Medicaid Home and Community Based Services (HCBS) despite the known effectiveness of this intervention. To optimize PA implementation within Medicaid HCBS, understanding client preferences for PA programming is needed. Thus, the objective of this exploratory qualitative study was to identify the PA preferences of Home and Community-Based Services (HCBS) clients including mode, duration, implementation strategy, and frequency, as well as barriers and motivators to PA.

NUMBER OF SUBJECTSWe conducted hour-long semi-structured interviews with n=6 participants (age range 72-80 years old) receiving HCBS in the Illinois Chicagoland area. 83% of participants were female, 83% of participants were non-Hispanic Black, and 17% of participants were non-Hispanic White.

MATERIALS/METHODSWe recruited participants from the Illinois’ Department on Aging Community Care Program. We conducted semi-structured interviews in participants’ homes which were audio recorded, transcribed, and analyzed using Dedoose (version 7.0.23). We derived semi-structured interview questions from the Health Belief, Social Cognitive, and Health Action Process Approach framework. We used a structured coding approach using conventional content analysis to derive codes from the text. We then applied codes to each interview and examined frequency of coding to determine themes.

RESULTSBarriers to PA were referenced nearly twice as frequently as PA motivators (barriers n=54, motivators n= 29). Comorbidities were the primary barrier while social support by a peer or instructor was the primary motivator for PA. The preferred mode of PA was walking completed 2-3 days per week. Duration of preferred PA varied from 20 minutes to 2 hours with great variability in individual preferences between-participants.

CONCLUSIONSVariability in individual preferences for PA may be due to the large number of and various types of PA barriers. This variability is likely explained by our findings of co-morbidities (an individual level barrier) are the primary barrier to PA. This individual level barrier creates unique situational challenges for PA participation. Our findings show that individual-level factors most significantly influence PA participation and should be addressed among Medicaid HCBS clients. Clients also preferred individualized PA instruction versus a passive strategy such as pamphlets or videotapes. Clients voiced concern about PA being implemented within the Medicaid HCBS system due to concerns that PA time would take away from other care services.

CLINICAL RELEVANCEPhysical therapists must consider individualized barriers and motivators to PA when recommending PA programming. Addressing comorbidities and preferred forms of social support are likely to increase PA adherence. When creating a plan of care, physical therapists should prescribe PA that facilitates the highest levels of self-efficacy among patients.

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POSTER PRESENTATIONS

A Brief Intervention Model of Physical Therapy Within the Community Health Care Center PRESENTED BYSartor-Glittenberg C, Hodges C, Burch AL, Bay C, Ibarrola RT, SunigaCadavid M Cecelia Sartor-Glittenberg

PURPOSE/HYPOTHESISThe purpose of this platform is to introduce a unique model for physical therapy (PT) intervention in a community health care center (CHC) for the provision of PT services to underserved populations with chronic low back pain (LBP).

DESCRIPTIONBack pain is one of the top reasons adults seek healthcare services.(1) Adults in poor families are more likely to have back pain than adults in families that are not poor.(2) Having no insurance is inversely associated with PT use for persons with LBP(3) and being Hispanic or nonwhite may be associated with receiving fewer PT services for low back pain.(4)Community health centers are outpatient clinics that serve medically underserved populations.(5) In 2015, 92.2% of persons seen in CHCs in the US were at or below the 200% poverty level and 24.4% were uninsured.(6) Physical therapy is not routinely provided at CHCs.(5, 7) We provide pro bono PT services at a CHC to a predominantly Hispanic population who are uninsured and a majority of the patients seen have LBP. Individuals seeking care have limited knowledge of back care and usually are only seen for one PT session. Our goal is to deliver the most efficient, effective, evidence-based interventions for these individuals, particularly since we may only see them once.The importance of exercise (8) and education (9) in the effective management of LBP is recognized. Brief intervention is a patient-centered approach that uses therapeutic or preventative consultation of short duration aimed at changing behavior.(10) Brief intervention may be effective for reducing pain in persons with LBP.(11) Our brief intervention model for persons with LBP uses a measure to identify clinical signs and symptoms and match a person’s impairments to specific exercise interventions.(12) Our model also incorporates a novel approach to education in back care using motivational interviewing.(13, 14) A brief intervention model which incorporates patient-specific exercise and motivational interviewing may be a way of providing efficient quality care for persons with LBP at CHCs who may not otherwise receive PT services.

SUMMARY OF USEFor this platform, the brief intervention model protocol will be presented utilizing data from an ongoing randomized clinical trial, investigating the effect of a brief intervention model of PT for reducing pain and improving function in persons with LBP in the CHC setting. Quantitative and qualitative results from two participants enrolled in this trial will be presented to conference attendees to illustrate the brief intervention model of PT. We will show findings of reduced pain and improved function for a participant who received brief intervention PT as compared to a participant who received standard instructions in back care.

IMPORTANCE TO MEMBERSThis platform will introduce conference attendees with an interest in provision of PT to underserved populations in the community to a brief intervention model of delivery of PT designed to be sustainable and empower the patient with knowledge of self-management of conditions such as LBP.

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Factors That Influence Selection of Initial Employment by New Graduate Physical Therapists PRESENTED BYLaura White

PURPOSE/HYPOTHESISPhysical therapists (PTs) are in high demand in the U.S. healthcare workforce. Most published PT supply-demand projection models predict that the supply of PTs in the workforce will not meet the growing demand, resulting in a shortage of PTs in the U.S. workforce through the year 2025. Due to the increasing shortage of PTs, employers spend significant financial and human resources to recruit new graduate PTs. Factors that influence new graduates’ initial employment decisions in the current healthcare environment have not been identified. The purpose of this study was to describe employment patterns of new graduate PTs and determine the factors that influence their selection of initial employment.


MATERIALS/METHODSAn online survey was developed and piloted for content validity and clarity. Survey items addressed characteristics of new graduates’ initial jobs and factors that influenced their employment decisions. 263 alumni of the University of South Alabama entry-level physical therapy program who graduated in the years 2005-2014 were invited to participate.

RESULTSNinety-seven alumni completed the survey, with a response rate of 36.9%. The most common settings in which new graduate physical therapists took their first jobs were acute care hospitals (26.8%), private outpatient offices or group practices (25.8%), and health system or hospital-based outpatient facilities (22.7%). Seventy-nine (84.0%) respondents rated practice area/setting as being an extremely or very important factor that influenced the selection of their first job, followed by job security (77.6%) and pay/benefits (73.4%). The factors most frequently rated as “slightly important” or “not important” were sign-on bonus/scholarship (47.9%), opportunity for promotion (30.4%), and autonomy (26.1%).Twenty-seven (28.7%) respondents accepted their first job at a previous clinical site.

CONCLUSIONSThe finding that pay/benefits was ranked as the third most important factor is not surprising given that it has ranked high in other published studies. However, this study suggests that practice area/setting and job security may be important to a greater number of new graduate PTs. This study confirms that clinical experiences during entry-level education influence new graduate PT initial employment decisions.

CLINICAL RELEVANCEThe findings of this study suggest that, when developing recruitment strategies, employers should consider factors within their control that new graduate PTs view as most important, such as job security, pay/benefits and expertise of staff. Because both positive and negative clinical experiences can influence students’ employment decisions, employers should evaluate the effectiveness of a clinical education program as a means to recruit new graduate PTs.

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Special Olympics Healthy Athletes ® and Fall Risk in People with ID: An innovative community-campus partnership PRESENTED BYGolub-Victor A, Fitzpatrick DF, Dodman M, Mazzone L, Ross BT Ann Golub-Victor

PURPOSETo establish a community-campus partnership with a local program for people with ID to examine fall risk.

DESCRIPTIONAdults with intellectual disabilities (ID) experience disparities in health, including impaired balance, at a higher rate than adults without ID. Comorbidities associated with ID, earlier effects of aging, and reduced physical activity contribute to a higher risk for falls in this population. Reliability of commonly used measures of balance has yet to be established for community-dwelling adults with ID and is needed to understand fall risk and the effectiveness of interventions for this population. To begin this work, critical stakeholders including adults with ID, community program directors and physical therapists must be identified and connected. Physical therapists are essential in assessing and addressing fall risk. Physical Therapy educators have a duty to prepare physical therapists to meet the health needs of this vulnerable population, thus fostering social responsibility, advocacy and excellence in clinical practice.

SUMMARY OF USEFaculty at an entry-level doctor of physical therapy program collaborated with Special Olympics of Massachusetts Healthy Athletes ® to identify a local sport and activity program for community-dwelling adults with ID. Strategies including ongoing communication, discussion with its parent group, and site visits during regular programming were utilized to establish a partnership with the program. These served to identify shared values, needs and general abilities of program participants. In addition, four tests from the Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative of the Centers for Disease Control and Prevention were selected and were piloted. These tests have been determined to be reliable and valid for assessing fall risk in older adults without ID.

IMPORTANCE TO MEMBERSThis project illustrates an innovative community-campus partnership that was facilitated by a state affiliate of Special Olympics, an organization dedicated to meeting the health and wellbeing of people with ID. Special Olympics Healthy Athletes’ ® goals and values are in synergy with those of the physical therapy profession. Both seek to promote sustainable programs at the individual and community level that foster optimal movement, health and wellbeing.

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Health and Fitness Outcomes Among High School Adolescents From Medically Underserved Populations (MUP) PRESENTED BYNunez-Gaunaurd A, Jaffe LA, Kuik M, Mena J, Mezzasalma E, Mitchel R, Gaunaurd IA, Raya M Annabel Nunez-Gaunaurd

PURPOSE/HYPOTHESISMedically Underserved Populations (MUP) are specific sub-groups of people living in a defined geographic area with a shortage of primary healthcare services, including but not limited to economic barriers. A physical therapy led health and fitness school-based screening was conducted at a South Florida high school with a MUP designation due to low income. The purpose of this investigation was to describe health and fitness related outcomes among high school adolescents from underserved populations. Correlations between waist to height ratio (WTHR) on aerobic and functional capacity are further examined as WTHR may identify cardiovascular disease risk.

NUMBER OF SUBJECTSSixty-three high school adolescents (males n=28, females n=35) with a mean age of 15 years.

MATERIALS/METHODSSubjects were characterized into healthy weight, overweight, and obese categories based on BMI and as having high abdominal adiposity based on a WTHR cutoff of >.5. Performance measures assessed included the six minute walk test (6MWT), Timed Up and Down Stairs (TUDS), sit-to-stand (STS), and pushups. Pre/post heart rate (HR), and blood pressure were assessed with the 6MWT. T-test analysis examined differences in WTHR and aerobic and functional capacity tests.

RESULTSSixty-eight percent of adolescents identified themselves as either Black or African American and 32% as Hispanic. Thirty-five percent of adolescents were characterized as overweight and obese (OW/OB). Study sample mean BMI was 20.22 and 25.20 for males and females, respectively. In males, mean WTHR = 0.409 (SD = 0.034), mean TUDS = 8.10 s (SD = 2.09), and mean 6MWT=525.5 m (SD = 59.91). In females, mean WTHR = 0.462 (SD = 0.22), mean TUDS=8.12 s (SD = 59.91), and mean 6MWT=484.1 m (SD = 59.82). Adolescents with a high WTHR had significantly higher resting HR (82 vs 72 bpm) and systolic BP (128 vs. 113 mmHg), walked less distance in the 6MWT (470 vs 511 m), had slower TUDS duration (11.3 vs 8.8 s) and completed less pushups (7 vs 15.7) when compared to peers with normal WTHR. Significant (p<.05) correlations were found between BMI and 6MWT (r = -0.40); WTHR and 6MWT (r = -0.39); and TUDS and 6MWT (r = -0.26).

CONCLUSIONSIn this cohort of high school adolescents from MUP, WTHR criteria >0.5, identified early cardiovascular risk factors including higher resting heart rate and systolic blood pressure and less musculoskeletal endurance. Disparities in functional and fitness outcomes were present among adolescents with a WTHR >.5 compared to their peers with normal WTHR. Both BMI and WTHR had similar negative correlations with TUDS and 6MWT performance.

CLINICAL RELEVANCEOur results indicated that use of a WHTR criterion ≥ 0.5 among adolescents from racially diverse and MUP were more likely to present with higher resting HR and systolic BP and less musculoskeletal endurance. Faced with an obesity epidemic, school health screenings and the use of proposed cut-off points for WHTR may assist to identify cardiovascular risk factors and refer adolescents for further evaluation and physical therapy intervention.

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Filling the Gap! Pro Bono Care with Student Physical Therapists: A Pilot Study PRESENTED BYCrandell C, Black JD, Dole RL, Palombaro KM Catherine Crandell

PURPOSE/HYPOTHESISOffering pro bono services has a long tradition in a number of professions including law and medicine. The medical profession has traditionally acknowledged the importance of delivering care to those unable to afford services. To help fill this gap, many medical schools have created free clinics where medical students provide clinical care under the supervision of licensed mentors. While pro bono services within the medical and legal professions are well established, the physical therapy (PT) profession is relatively new and little is known about the prevalence and characteristics of PT pro bono services. The purpose of this study was to conduct a survey of PT programs in the United States to determine the prevalence and characteristics of pro bono services involving physical therapist students.

NUMBER OF SUBJECTSThis survey was distributed via SurveyMonkey to 226 emails representing PT program directors as well as faculty known to be involved with students in physical therapy pro bono services. 40 surveys were collected (17.7% response rate).

MATERIALS/METHODSThe research instrument, developed and piloted by the investigators, consisted of a 52-item electronic survey including demographic information followed by a series of multiple-choice questions to identify prevalence and characteristics pro bono service opportunities available to physical therapist students in the United States. This project was IRB approved by Widener University.

RESULTSOf the 40 responses, 32 offered pro bono services representing a wide variety of characteristics. Most were freestanding PT clinics in connection with their academic institution and operated 2 times per week year round. Many involved student leadership in both client care and clinic operations and had a 1-to-4 ratio of faculty to student supervision. Length of time in operation ranged from less than 1 year up to 20 years. Most had started within the last 3 to 5 years. Due to the low response rate, informal communication with 248 PT programs yielded responses from 187 programs with 160 programs indicating provision of pro bono services.

CONCLUSIONSPro bono services within the PT profession are on the rise. Programs have found creative and varied ways to conduct services within their institutional structures to fill the gap for both student professional development and community health and wellness. The primary limitation of this research was the low response rate.

CLINICAL RELEVANCEThe top 3 reasons for provision of pro bono services included affording students clinical skill practice, fostering students’ development of professional behaviors and aligning with PT program mission. Pro bono services within health professions such as medicine and PT continue to provide a safety net for individuals who are uninsured and underinsured. Moreover, PT pro bono care is reflective of our call to embody the APTA Vision Statement, Core Values and Code of Ethics. Further research is needed to determine prevalence and to define characteristics for best-fit and promising practices of pro bono services within the physical therapy profession.

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Evaluation of International Service Learning Trips: Innovative Travel Blog AnalysisPRESENTED BYHager S, Wiese SM, Sherd K, Kerfeld CI Cheryl Kerfeld*

PURPOSE/HYPOTHESISGlobal Health service-learning (S-L) offers students educational opportunities including cultural competency acquisition combined with professional development. Global Rehabilitation Organization at Washington (GROW) is a University of Washington (UW) student run organization founded on five phases of the Conceptual Model of Optimal International Service-Learning: development, design, implementation, evaluation, and enhancement. As GROW has matured in sustainability, it has focused on advancing the evaluation and enhancement phases. The purpose of this study is to describe an innovative qualitative travel blog analysis to report on learning objectives met following GROW’s international S-L trips.

NUMBER OF SUBJECTSEight international S-L travel blogs.

MATERIALS/METHODSUsing a qualitative directed thematic approach, 4 researchers coded, sorted, organized, and summarized data from 8 international S-L travel blogs into key themes. Combined PT, OT, and P&O program transcurricular objectives were used for initial coding. Text that couldn’t be categorized within this coding scheme was given a new code. Final themes included: Cultural competency, critical inquiry and decision making, sustainability, rehabilitation professional as leader/educator, interprofessional collaboration, creativity in practice, effective communication, safe and efficient practice, therapeutic use of self, adaptability/flexibility, and professionalism. Member checking included providing a summary of themes to bloggers and inviting feedback on whether the summary reflected their viewpoints.

RESULTSResearchers coded 429 total excerpts in the 8 blogs. Themes including cultural competency, critical inquiry/decision making, and therapeutic use of self were found in all 8 blogs. Cultural competency and critical inquiry/decision making had the highest number of excerpts. Therapeutic use of self, adaptability/flexibility and professionalism had lowest number of excerpts.

CONCLUSIONSUW GROW students who attend international S-L trips gain valuable skills that meet program transcurricular objectives. Coding showed consistency between interprofessional transcurricular and GROW S-L objectives. Final themes provided evidence that students use their unique learning styles to adapt to new environments. Students are also able to share their unique insight in gaining skills and cultural understanding while providing care to underserved populations. Strong, but informed bias is the main limitation of using qualitative directed approach analysis. Further evaluative work should be done to educate students and faculty about the benefits of global health service-learning trips.

CLINICAL RELEVANCEStudent and faculty involvement in global health S-L has grown and should be influenced by research and best practice. Qualitative travel blog analysis is an innovative research method that can be used to assist S-L global outreach programs in describing student experience for betterment of their careers and practice, as well as sustainable global relationships.

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Sustainability of Student-Run Service Learning OrganizationsPRESENTED BYCoombs A, Rissman C, Kerfeld CI Cheryl Kerfeld*

PURPOSEThe purpose of this platform is to highlight barriers, solutions, and critical elements in the creation and sustainability of successful student-run service-learning (S-L) organizations via exploration of diverse interprofessional S-L opportunities offered by the University of Washington (UW) Department of Rehabilitation Medicine.

DESCRIPTIONThe UW Department of Rehabilitation Medicine offers unique opportunities for participation in student-run S-L organizations. Students within the Doctor of Physical Therapy (DPT) program engage with their local community while developing valuable leadership skills. Integration of S-L has positive impacts on academic learning, cultural competency, community service after graduation, and interpersonal development. Student-run organizations are valuable in their ability to generate trust and partnerships between students and faculty members, as well as with members of the community, while fostering future preceptors. However, sustainability of these organizations may be complicated by factors including balancing student leadership with rigorous academic demands, engaging and managing student involvement, partnering with other health profession programs due to program-specific scheduling constraints, securing dedicated faculty support, and engagement with academic and legal rules and regulations. We have identified critical elements within student-run S-L which foster sustainability: use of strategic leadership, dedicated interprofessional faculty involvement, communication between health professions, and development of support from the university. In this report, strategic leadership theories are applied to three student-run S-L case studies from the UW DPT program: Latina Health Fair, Dance for Parkinson’s disease, and the University District Street Medicine Pro Bono Clinic. These organizations represent different stages of project development and are used to examine diverse aspects and strategies for sustainability.

SUMMARY OF USEThe UW Department of Rehabilitation Medicine has increasingly utilized models for S-L opportunities featuring student leadership. Sustainability is a growing concern as students graduate and pass leadership on to the next cohort. Maintaining the structure and foundational principles of S-L organizations should not solely be incumbent upon sponsoring faculty but also be integrated into project cycles and leadership content of organizations themselves.

IMPORTANCE TO MEMBERSStudent-run service learning organizations are beneficial within DPT programs for students, faculty, and the greater community which they seek to serve. This platform is designed to provide a framework for sustaining student-run service-learning organizations within a DPT program.

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Patient Independence and Falls Reduction in Inpatient Rehabilitation : A Team Approach PRESENTED BYDebra Ness

PURPOSEPrimary Goal: Reduction of patient falls on the inpatient rehabilitation unit. Secondary Goals: Increased interdisciplinary decision making and communication regarding patient readiness for independence; development of a room communication board.

DESCRIPTION59 patient falls were recorded at the Mayo Clinic inpatient rehabilitation unit, Rochester Mn in 2014. A majority of these falls happened in the patient room during mobility or transferring tasks. It was determined that many of these falls occured because of miscommunciation between therapy, physician and nursing staff in regards to patient assistance needs. A multidisciplinary team was formed to analyze the situation and develop a plan for improvement.

SUMMARY OF USEThe quality improvement project developed multiple areas of practice improvement. A pre and post implementation survey was sent to therapy and nursing staff asking about their involvement in decision making regarding patient safety in the room. A patient room communication board was developed with headings for mobility, independence status,dysphagia, communication and cognitive strategies, family questions and patient goals. Patient safety and readiness for independence became a standing discussion point during patient care rounds and is entered as a physician order. A policy was developed that patients are not allowed to be in the bathroom without a staff member being within arms reach at all times. A staff education video was developed to model ideal patient care round discussion, correct filling out of the patient room communication board, and falls reduction measures.Audits of communication board accuracy, staff involvement in decision making and patient fall incidence was conducted over 2 yearsOutcomes:Patient Falls reduced by 63% (2014: 59, 2016: 35) Falls with harm reduced 54%Compliance of communication board completion increased 74%: (2014: 21%, 2016:95%)Staff involvement in decision making survey increased 21%:(2014: 64%, 2016:85%)

IMPORTANCE TO MEMBERSPatients on inpatient rehabilitation units are at an increased risk for falls due to mobility and cognitive impairments. It is estimated that a single fall can increase hospital costs by up to $13,316.(4) In addition, Centers for Medicare and Medicaid Services consider a fall a preventable hospital acquired injury that may not be reimbursable. Ineffective team communication between nursing and therapy staff regarding patient abilities can increase patient falls if mobility status isn’t clearly articulated to all team members. In addition, independence in mobility is often a goal for patients on an inpatient rehabilitation. Timely assessment and implementation of patient independence in mobility and self cares leads to improved patient satisfaction. Collaborative communication is crucial to successful teamwork resulting in positive patient functional and satisfaction outcomes.This project improved gaps in team communication regarding mobility status while allowing appropriate patients to practice independence and reduced falls on the rehabilitation unit.


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Does Active Goal Setting, as an Intervention, Improve Treatment Outcomes for Patients Receiving Physical Therapy? A Systematic Review PRESENTED BYHaladay DE, Calantoni A, Knight M, Moser G, Taylor B, Anderson S, Heintz M Douglas Haladay

PURPOSE/HYPOTHESISThe present healthcare environment emphasizes patient-centered practices, including goal setting, however little is known about the impact of goal setting on outcomes in physical therapy. Therefore, the purpose of this review was to determine if active goal setting improves treatment outcomes for patients receiving physical therapy.

MATERIALS/METHODSA search of PUBMED, CINAHL, and Embase, was completed from 2000 to October 2016. Inclusion criteria included peer-reviewed studies, published in English, that examined a form of active goal setting as an intervention for patients receiving physical therapy. We determined the definition of goal setting in PT is when the PTs, patient/family, or both work together to determine individually meaningful functional goals for the patient to accomplish as a result of PT treatment. Case-studies/series and narrative studies were excluded. Two reviewers independently completed the selection process and then reached consensus regarding study inclusion. Four reviewers independently assessed each study for methodological quality using the PEDro Scale. Disagreements were resolved by consensus. Percent agreement and kappa statistics were calculated for each of the individual PEDro criterion to assess inter-rater reliability.

RESULTSThe search of MEDLINE, CINAHL, Embase, and PEDro produced 3039 articles for review. Eight studies fulfilled the inclusion criteria and were included in this review. Consensus quality assessment scores ranged from 1/10 to 9/10, with an average of 3.67/10. Of the studies included, there was one high, three fair, and five low quality studies. Patient populations included those with neurological, musculoskeletal, geriatric, rheumatological, and cardiopulmonary diagnoses. Percent agreement and kappa values for individual criteria scores ranged from 67% to 100% and 0.33 to 1.00, respectively. All studies found that goal setting as an intervention had a positive effect on physical therapy (e.g. goal achievement, effect on patient-provider relationships), while 7/8 reported improvement in impairment and/or functional measures.

CONCLUSIONSThis systematic review indicates benefit of active patient involvement in physical therapy goal setting on outcome. However, we review found inconsistency in goal setting practices and procedures. The true value of these programs will not be known until active goal setting is well-defined and examined for validity and reliability. There is a need for further studies involving more physical therapists and long term follow to determine the effect of active goal setting on outcome.

CLINICAL RELEVANCEGoal setting is a common practice in physical therapy, however diverse goal setting practices and procedures exist. Active, goal setting appears to have a positive impact on patient outcomes in a variety of patient populations and settings, however the evidence supporting goal setting as an intervention is limited and of low quality at this time.

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Same-day Physical Therapy Consults in a Neuromuscular Disease Physician Clinic: A Conceptual Model of Care PRESENTED BYPucillo EM, McIntyre MM Evan Pucillo

PURPOSE/HYPOTHESISThe University of Utah is a large academic hospital uniquely located in the heart of the intermountain west region and serves an extremely large geographic area and diverse population.1 Given the scarcity of resources inherent to this largely rural area, patients with NMD often have unmet rehabilitation needs that are complicated by geographic separation from expert care centers.1 This presents a unique opportunity for physical therapists (PTs) to have immediate access to persons with NMD in a physician-led outpatient clinic.

DESCRIPTIONNeuromuscular disorders (NMD) often require care from a multidisciplinary team of expert clinicians who manage the progressive nature of the disease.1-3 Therefore, multidisciplinary team-based care is an attractive model for patients with NMD and is appropriately aligned with the Centers for Medicare and Medicaid services triple aim: better health, better care, and lower costs through improvement of services.1,4,5 Novel use of physical therapists was conceptualized using a same-day consultation model to better serve the rehabilitative needs of persons with NMD and to assist in the coordination of care.

SUMMARY OF USEPatients with NMD may access the University of Utah in Salt Lake City from up to 300 miles away in the surrounding intermountain region. Around one-third of this NMD population travels over 60 miles in one direction to access expert care.1 Physicians from the neuromuscular division of medicine subscribe to, and endorse, the same-day PT consults model. NMD physicians using this model streamline their visits and devote greater time to more medically complex cases instead of taking time to ascertain a patient’s functional, strength, or balance impairments. PTs have direct and immediate access, communication, and collaboration with physicians, nurses, clinical pharmacists, and clinic support staff to coordinate patient care. Protocols and algorithms were developed to assist physician providers in decision-making when accessing same-day PT consultations.

IMPORTANCE TO MEMBERSUse of this model has the potential to more immediately address the various rehabilitative needs of patients with NMD that may go unmet in standard physician care. The role of the specialized physical therapist in this model is two-fold: 1. To provide immediate access to physical therapy examination and evaluation in a collaborative environment, and 2. To facilitate the coordination of care between the patient, physician, clinical nurse and support staff, and outgoing community referrals. Preliminary study supported the use of this model through patient satisfaction scores.1Further study is needed to understand the financial sustainability, transferability, and applicability of this model to other institutions with varying demographics and geographical limitations.

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Factors Affecting G-Code Prognostic Accuracy in Medicare Beneficiaries Receiving Outpatient Physical Therapy PRESENTED BYHartley GW, Roach KE, Buisson VM, Fath P, Miller JR

PURPOSE/HYPOTHESISFor patients with Medicare Part B, physical therapists (PTs) must establish initial and goal G-code severity modifiers (SM) as part of a plan of care. A proxy for predicted functional change may be the difference between initial and goal SM. In patients where actual change in SM is different than predicted change, the estimation was inaccurate. The purpose of this study was to compare patients who missed the SM goal to those who met the SM goal in order to identify characteristics that may affect prognostic accuracy.


MATERIALS/METHODSPTs at 3 outpatient rehabilitation facilities recorded G-code SM’s, gait speed, and Limitation in Mobility Activities Test (LIMAT) for patients with Medicare Part B. The LIMAT is a measure of mobility composed of 26 transfer and mobility items scored by ‘degree of difficulty’ and ‘level of assistance’. Higher scores indicate greater limitations. Reliability and validity of the LIMAT has been reported previously. The 7 G-code SMs (0%, 1-19%, 20-39%, 40-59%, 60-79%, 80-99%, and 100%) were coded as an ordinal variable ranging from 0 to 6. Change scores were calculated by subtracting discharge scores from initial scores for all variables. Subjects whose actual change was less than predicted change in SM score were classified as not meeting goals. Chi-square, student’s t-test, and Mann-Whitney-U were used to compare groups. Paired t-tests and rank sum tests were used to examine within group changes.

RESULTS29.3% of the subjects missed their SM goals indicating inaccuracy in prognosis. Subjects who missed vs met goals were very similar in initial SM score (3 v 3), gait speed (0.7 v 0.7 m/s), LIMAT score (47.3 v 47.7), and age (72.9 v 74.4 years). The proportion of subjects who missed goals were similar across ethnic groups, but more male (38.9%) v female (25%) subjects missed their goals. Only 12.5% of subjects with acute orthopedic diagnoses (dxs) missed goals versus 40% with chronic dxs. Subjects who missed goals had a higher predicted SM change than those who met goals (2 vs 1 levels) but lower actual change (1 v 2 levels, p<.0001). Both subjects who met and did not meet goals improved significantly on gait speed and LIMAT score (p<.0004). However, subjects who missed goals had smaller changes in LIMAT score (12.2 v 22.9, p=.01) and gait speed (0.15 v 0.2 m/s, p=.01) than subjects who met goals.

CONCLUSIONSPrognostic accuracy for improvement in SM appears unaffected by age, ethnicity or severity of initial activity limitations. It does appear to be affected by medical diagnosis. Prognostic accuracy of SM goals appears best for acute orthopedic dxs and worst for chronic conditions. Interestingly, patients who missed goals had a larger predicted improvement and a smaller actual improvement than patients who met goals.

CLINICAL RELEVANCEWhile the PTs in this study were accurate in setting G-code SM goals for acute dxs, they appeared to be overly optimistic for chronic dxs. Further study is warranted since generalizable results could have significant Medicare policy implications in the future.


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Team Work Makes the Dream Work: Interprofessional Collaboration in Student-run Pro Bono Clinic PRESENTED BYKrempasky J, Black JD

BACKGROUND AND PURPOSEThe student-run pro bono clinic at Widener University has been offering physical therapy services to clients in the community who are uninsured or underinsured since September 2009. To date, students have delivered over 5000 physical therapy visits. In 2016, Occupational Therapy services and Clinical Psychology services were added. The purpose of this case report is to describe the nature of the interprofessional collaborations, their inception, and the outcomes for all constituents involved.

CASE DESCRIPTIONIn August of 2015, Philadelphia University and the Chester Community Physical Therapy clinic expressed a mutual desire to have occupational therapy services offered in the clinic. Philadelphia University expressed a willingness to operate on the student-run model. DPT student leaders collaborated with the OT student leaders while Widener faculty and Philadelphia University faculty supported the collaboration. OT services began one night/week in January 2016 and expanded to two nights/week in September 2016. Simultaneously, Widener’s Graduate Clinical Psychology program expressed an interest in placing a psychology graduate student into the clinic to screen clients for any psychological needs. The psychology intern would be present most open clinic nights and would ask willing clients to complete psychological screening tools, provide in vivo treatment sessions to clients experiencing difficulty or anxiety, and set-up outpatient psychological counseling services to those interested. Clinical psychology began their services in September of 2016. Both Clinical Psychology and the OT students participated weekly in the PT Grand Rounds where client cases were discussed in a team approach.

OUTCOMESOutcome measures will include statistics for number of clients seen and reflections from students, faculty and clients engaged in the collaboration. Updated outcome data will be collected and analyzed in December of 2017 and will be available to report at CSM2018. Preliminary data from the first year of collaboration shows that the OT students delivered 196 OT client visits within the pro bono clinic and the clinical psychology student intern administered a total of 38 screening tools to clinic clients; provided 54 in vivo sessions to clinic clients while participating in their therapy; and acquired 10 outpatient counseling clients. Student reflections and client satisfaction surveys demonstrated a great appreciation for the interprofessional collaboration.

DISCUSSIONThe interprofessional collaboration between OT, PT, and the Clinical Psychology students have been beneficial not only to the clients, but to the graduate students as well. They have had the opportunity to learn from one another and grow in their interdisciplinary communication and teamwork by working with authentic clients within a practical clinical setting. These students will graduate prepared to work collaboratively with other professions to address client needs.

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Building Cultural Bridges: Health Promotion with the Hmong Community PRESENTED BYAnderson S, Falk CA, Gmiterko N, Reff TA, Ruhland K, Lojovich JM Jeanne Lojovich*

PURPOSE/HYPOTHESISThe largest concentration of Hmong in the United States currently reside in the Twin Cities metro, with over 66,000 living in Minnesota.1 Traditionally, in Laos the Hmong culture has many aspects of a healthy lifestyle. However in the US, Hmong children have higher rates of obesity, high blood pressure, and diabetes compared to Hmong children in Laos.2,3Several studies focusing on the US Hmong population have indicated a need for physical health and nutritional interventions to address the risk factors associated with obesity, diabetes, and high blood pressure in Hmong youth.2-4 The purpose of this project was to educate children of Hmong descent about health and wellness in a culturally competent manner.

DESCRIPTIONThis project focused on promoting physical activity and eating healthy food within the context of Hmong cultural practices. The Hmong culture believes in the concept of being in balance with health (hauv nruab nrab) and restoring balance by participating in certain activities and eating specific foods (caiv).5 The project focused on the balance of health and restoring the balance by creating healthy meals with a variety of food groups, education on serving sizes and amount of sugar in drinks, exposure to health care professionals, and various ways to exercise and stay active. During the two weeks of Hmong Cultural & Language Camp at Concordia University St. Paul, students tracked their daily amount of physical activity to see if they were meeting the suggested national levels.

SUMMARY OF USEFifth and third grade students completed a ten-question pretest on the first day of class that tested their current knowledge regarding physical fitness, nutrition, and general health. The students then took the same test on the last day of the two-week class. A total of 27 students took the pretest and 30 students took the posttest. Due to attendance differential, only the students that completed both the pretest and posttest were used for analysis. Results of a paired t-test showed a p-value of <0.0001 indicating statistical significance and improved health knowledge over the course of the two week camp experience.

IMPORTANCE TO MEMBERSAs future physical therapists, interacting with multiple cultures and children of all ages is integral to the profession. And social responsibility within the Physical Therapy is one of the APTA Core Values. Therefore, this project’s goal of promoting healthy behaviors among Hmong children is important in developing healthy behaviors over the course of their lifespan. This project also helped us as DPT students learn more about Hmong culture and practices to benefit our future patients. Pretest and posttest data demonstrated that culturally integrated health education within this population was an effective way to promote health behaviors. In the future, Physical therapists can use concepts from this project to promote community health and wellness to a variety of different cultural groups.

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Development of a Balance Screening Program for Low-income Older Adults PRESENTED BYCooper CT, Eisenhuth R, Hansen R, Mattson T, Noll A, Van Der Weerd K, Lojovich JM Jeanne Lojovich

PURPOSE/HYPOTHESISAccording to the CDC more than one third of adults aged 65 and older report at least one fall and 2.5 million older adults are treated in emergency departments for fall injuries each year. The purpose of this project is to provide balance screens and education to the low income, older adult population in the St. Paul, MN area to prevent falls and improve their quality of life. This community has over 600 units of low income housing and 476 households, 87% of the population lives independently and 41% of the population is over the age of 51. With a large percentage of the population living alone and potentially at risk for falls, this group could greatly benefit from falls risk assessment and fall prevention information. Balance screens and education are simple and relatively inexpensive interventions that have a high efficacy to decrease falls.

DESCRIPTIONA community needs assessment was initially completed to provide a greater understanding of the health related needs of older adults living in low-income housing in St. Paul. The subsequent project entailed the development, implementation and execution of a balance screening and falls prevention education program with St. Paul Public Housing by DPT students. The balance screening program included six stations: patient intake, vitals, three balance assessments, and exit counseling. The exit counseling station at the end reviewed results of the assessments with participants and instructed them in resources and exercises designed to improve their impairment. After completing our initial balance screening day, a follow-up visit occured two months later. The purpose of this follow-up visit was to check back in with participants of the previous balance screening, provide further instruction on how to progress exercises, and to answer any type of questions that may have arose.

SUMMARY OF USEA survey was distributed to the residents with four follow up questions to evaluate the effectiveness and applicability of our balance screen and falls prevention education. When averaging the results of the follow up survey, 94% of the residents were highly satisfied with the program.

IMPORTANCE TO MEMBERSThe results of this project identified a high satisfaction rate with the balance screens and education provided to them for future fall prevention. Many of the residents had reported falls or a fear of falling. This screening program assessed where participants were the most vulnerable, and provided them with education and resources on how they can improve their health. The importance of this project was to screen and identify individuals that may be at a falls risk in the various St. Paul Public Housing system. This project emphasizes the importance of providing care to under-served populations and demonstrated a high satisfaction rate of participants.

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The Impact of Part-Time, Collaborative Integrated Clinical Experiences on Revenue and Patient Satisfaction PRESENTED BYBell JJ, Ostertag SA, Levison DL, Carson JC

BACKGROUND AND PURPOSEClinical education is an essential part of DPT training and requires strong clinical partnerships and well-trained preceptors. A concern clinical sites express to academic programs is the cost to provide quality clinical instruction. Research shows that full-time clinical experiences do not decrease overall productivity of the supervising clinical instructor. However, no research has been presented on the impact of part-time, integrated clinical experiences (ICEs) on revenue and patient experience. The purpose of this study is to share a model for part-time ICEs in a university-based OP clinic utilizing a 4:1 student to preceptor ratio and its impact on revenue and patient satisfaction.

CASE DESCRIPTIONThe University of Montana PT program changed their clinical education curriculum to eliminate one full-time clinical experience and create two part-time ICEs in the on-site PT clinic. Core faculty serve as preceptors in a 4:1 student to preceptor collaborative model. During the second year spring semester and third year fall semester, thirty-four students spend two afternoons per week with an orthopedic or neurological patient population. Preceptors supervise four students working in collaborative pairs, and in compliance with state practice act supervision rules and modifying billing when needed due to payer rules. Patient satisfaction surveys were sent to patients following each episode of care to assess overall experience and specifically with students.

OUTCOMESSatisfaction and financial data from our first year of the ICE were compared to data prior to ICE initiation. Patient evaluations increased from 312 to 336 and visits increased from 3,614 to 3,927. The number of units billed decreased from 11,998 to 10,506 and units per visit decreased from 3.32 to 2.68. Overall cost to provide PT services decreased from $218,099 to $175,521. Annual revenue increased by $21,840. Patient satisfaction remained comparable. Prior to student involvement, 39 of the 40 patients who completed the survey reported they would return to the clinic in the future and 40 of 41 patients would recommend the clinic to a friend. After student involvement, 37 of 40 patients surveyed reported they would return and 38 of 40 would recommend the clinic to a friend. After the inclusion of student PTs, 25 out of 39 patients had a student involved in their care and 23 of 25 patients reported it was a positive experience working with a student.

DISCUSSIONThis model of part-time ICE in an OP clinic led to an increase in revenue. The revenue increase was linked to decreased cost to provide services through utilization of preceptors who supervise four students at a time. Patient satisfaction did not significantly change and showed patients had positive experiences with students. This model allowed an increase in capacity for patient care while utilizing faculty to provide quality instruction and supervision. Our experience suggests that using a 4:1 collaborative model can positively impact finances without compromising patient satisfaction.

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The Impact of a Community Based Exercise Program on Somali Immigrants Residing in Subsidized Housing PRESENTED BYMiller JB, Sellheim DO, Mueller LC, Berggren K, Gerardi M

PURPOSE/HYPOTHESISThe Somali immigrant population is a growing demographic in Minnesota. Although immigrants to the United States tend to be healthier upon arrival than the general population, their health deteriorates the longer they reside in the United States, with changes in diet and physical activity as contributing factors. This study explored the effects of a physical therapy student-led exercise program on Somali immigrants residing in Minnesota.

NUMBER OF SUBJECTSThis study used purposive sampling of thirteen volunteer residents of a subsidized housing complex in Minneapolis, MN.

MATERIALS/METHODSQualitative data were gathered using audiotaped focus group interviews. Eight female and five male Somali individuals were recruited from an existing exercise program within a subsidized housing complex in Minneapolis, Minnesota. A Somali interpreter provided translation services. Audiotapes were transcribed and data were coded using an inductive approach, with no predefined coding criteria or hypotheses, to generate categories from the raw interview data.

RESULTSSix major themes were identified from the data. These include: physical effects; emotional effects; integration of cultures; barriers and facilitators of participation; differences in physical activity between Somalia and the United States; and transferability of the exercise program. Emotional effects and cultural integration, rather than physical effects of the exercise program were found to be the primary benefit in participants’ responses.

CONCLUSIONSThe effects of participation in this student-led exercise program are consistent with findings from existing literature of programs designed for immigrant populations. This study adds to the existing literature by demonstrating the importance of connectedness between participants and group facilitators.

CLINICAL RELEVANCEResults and recommendations from this study can be utilized for future exercise programming initiatives with the immigrant Somali community in the United States.

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Transforming the Delivery of Total Joint CarePRESENTED BYFenimore J, Smith L

PURPOSETotal Joint Arthroplasty (TJA) is an intervention that is recognized as being highly successful for improving patient quality of life affected by arthritic pain (1,2). Its success is often measured in patient satisfaction, length of stay and improved quality of life (2,3). In 2010, over one million hip and knee arthroplasties were performed in the US (4,5,6). Healthcare delivery is frequently reforming and processes for TJA care have been varied and costly for hospitals (3,4) with reimbursement averaging $14,000 per surgery (7). Medicare reimbursement plans for TJA care can put hospitals at financial risk for cost and quality for up to 90 days (8). This platform describes the comprehensive quality process improvement in which Piedmont Fayette Hospital (PFH) transformed the management of their current TJA services with a standardized team approach to improve quality, safety and service.

DESCRIPTIONThe Orthopedic service line identified the need for standardization in the delivery of care for total hips and knees from pre-admission to post-discharge. This service line includes 21 surgeons. Each surgeon had a varied approach to the delivery of care.

An Ortho Navigator was hired to assist in the execution of the program. Team collaboration included selection of equipment and pre-op education content which afforded high employee engagement. Caregivers were included as “coaches” to attend therapy sessions, a guide book was provided before surgery and an online video resource demonstrating exercises led to higher patient satisfaction scores.

The transformation within the Rehab Department included standardization of the exercise program, group therapy times, Day of Surgery mobility for all patients by Rehab or Nursing. Communication with nursing assured optimal pain management and assistance with transportation to and from group sessions.

Volume of TJA Fiscal Year (FY) 15: 565 , FY17: 502 (through May 2017)Ave. Length of Stay for TJA FY15: 2.65, FY17: 2.00Likelihood to Recommend Scores (Percentile) FY15: 64, FY17: 89Day of Surgery Mobility FY15: 0%, FY17: 95%

SUMMARY OF USEPFH had varying approaches in the delivery of patient care for TJA patients. Variations included surgeons’ and anesthesiologists’ preferences for surgical planning, post-operative orders, frequency and type of pain management delivery, provision of nursing care, rehab treatment plan, hospital length of stay and discharge instructions and disposition.

IMPORTANCE TO MEMBERSPositive outcomes were identified after transforming the TJA program at PFH. There were decreased operating costs, improved work flow of the surgical suites, decreased hospital length of stay, improved patient satisfaction, standardization of care within disciplines and more patients were discharged home versus another level of care. The delivery of healthcare is constantly changing and therapists in the acute care setting must be agile in adapting to change. Collaboration among physicians, clinicians and executive leadership provides the most efficient and effective delivery of TJA care in an ever changing healthcare system.

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An updated profile and earnings analysis of U.S. physical therapists PRESENTED BYJulia Chevan

PURPOSE/HYPOTHESISThe purpose of this study was to describe the social and demographic characteristics of physical therapists, to examine the geographic distribution of physical therapists across the U.S and to ascertain if the gap in earnings that was based on gender, race and ethnicity has persisted.

NUMBER OF SUBJECTSThe 2010-2014 ACS file contained 15,719,324 unweighted cases from which we identified 9,996 physical therapist cases who were active in the workforce.

MATERIALS/METHODSThis study used data from the 2010-2014 American Community Survey (ACS) 5-year public use microdata file. The ACS is an annual nationwide survey conducted by the United States Census Bureau that provides detailed information about the population and workforce of the United States. This information was previously collected through the decennial U.S. census long form which was the data source for the 1998 study in which we first developed a profile of physical therapists in the U.S. Data from the ACS can be weighted to represent the entire U.S. population. ACS variables that characterized the physical therapy workforce in terms of geographic distribution, social characteristics, employment characteristics and earnings were used in this analysis.

RESULTSThe estimate of the number of physical therapists in the US workforce over the period of time from 2010-2014 was 196,434 (95% CI 191,638, 201,230). Of these, 69.4% (95%CI 68.3, 70.6) were female, 79.4% were white (95% CI 78.3, 80.6) Most therapists (69.5%) fell in the age range of 30-54 years. Ratios of physical therapists to population ranged from a high in the state of Vermont of 14.9/10,000 population to a low in Alabama of 3.6/10,000 population. The median value earnings for a physical therapist in 2014 dollars was $66,742.30 with a mean value of $70,215.95. The median earnings value was lower for women than men and lowest among Hispanic women.

CONCLUSIONSince the 1998 census-based study was published, the ratio of PT’s to 10,000 population has increased but geographic variation by state still exists. The profession is still predominantly female and white. Sex, race and ethnicity continue to influence earnings.

CLINICAL RELEVANCEThere is no standard for the ratio of PT’s to population which means that areas of excess and shortage cannot be defined. The influence of demographic variables on earnings remains troubling as does the demographic profile which indicates a lack of diversity in the U.S. population of physical therapists.

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An Investigation of the impact of social and physical participation on the quality of life of the elderly in a Nicaraguan adult care center PRESENTED BYBooth J, ferrero S, Mascali K, Moriarty K, Giordano J

PURPOSE/HYPOTHESISHealthcare initiatives focus primarily on the needs of women and children in Nicaragua, therefore, older adults are left with little to no medical benefits that support healthy aging.1 This lack of support and care can negatively impact their overall quality of life (QOL) and social functioning. Research suggests that developing countries tend to lack culturally appropriate information regarding factors associated with older adults and social participation. There is a need for healthcare professionals to develop programs that are easy to sustain in developing countries.2 The purpose of this study was to conduct a needs assessment to examine perceptions of occupational participation and QOL among residents living in an adult care center (Hogar), in Leon, Nicaragua. Based on the results, an activity program was designed and implemented to promote increased physical, mental, emotional well-being.

NUMBER OF SUBJECTS4

METHODS/MATERIALSIn this project, residents were recruited from the Hogar. They participated in semi-structured interviews and completed the Patient Specific Functional Scale (PSFS) to identify themes regarding occupational performance. Additionally, local stakeholders were interviewed to determine the fit between the needs of the residents and environmental factors. The first phase of the project was devoted to determining needs prior to program development and implementation. Four of the residents’ QOL were measured using the RAND 36-Item Health Survey (Version 1.0). Phase two of the project incorporated an interprofessional collaboration with PT and OT faculty and students to develop and implement the activity program, and seek feedback about the effectiveness of activities created. Collaboration with residents, staff, and PTA led to the development of a meaningful activity program. The utilization of goal-directed activities that motivate older adults to continue participating in activities has been indicated as an important factor for program sustainability.3 The activity program was implemented in January 2017.

RESULTSAfter collecting the data from the RAND 36-Item Health Survey, we determined that the residents scored lower than average in 7 out of 8 domains. Activities that have been shown to improve the quality of these domains in the elderly population were selected and incorporated into the activity book.

CONCLUSIONSThe Hogar residents’ lower than average scores on the RAND 36-Iteam Health Survey was the driving force for this research study. In hopes of improving their QOL resources that have been shown to improve quality of life in the elderly population were specifically selected. Our hypothesis is that the RAND 36 scores will increase significantly when re-administered in July 2017, 6 months post- intervention implementation.

CLINICAL RELEVANCEThis project recognizes the need for further investigation in the area of engaging older adults in meaningful activities in order to fulfill life satisfaction and quality of life for this growing cohort in Nicaragua.

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Marketing Services to Transform Society: How a Marketing Project has Fostered Student Leadership Growth while Achieving Referral of Clients in Need of Pro Bono Service PRESENTED BYGilfillan J, Rutledge P, Harmon L, McDevitt M, Black JD

BACKGROUND AND PURPOSEThe mission of our student-run pro bono clinic is to simultaneously improve healthcare access to physical therapy services by providing pro bono physical therapy services to the underserved and underinsured populations in the surrounding community, while educating a new generation of physical therapists in the areas of competency, character, citizenship, and social responsibility. A Student Board, consisting of 12 positions, is responsible for the administration and management aspects of the Clinic. In 2016, the Student Board recognized a need to increase marketing to referral sources and established a new position, The Referral Marketing Officer. The purpose of this project was to measure the effectiveness of the students serving in this new position during an introductory 6-month trial period.

CASE DESCRIPTIONThe Student Board charged the Referral Marketing Officers with tracking, communicating, and building relationship with referral sources. The two students named to this position set the goals of: 1.) Develop an effective mechanism to track data regarding patient’s referral sources; 2.) Establish communication with at least five new referral sources; and 3.) Acquire 40 new clients from referral sources. The intervention involved creating marketing materials for distribution, creating a tracking document, and conducting routine visits to current and new referral sources. An alumna of the program who now owns a private practice provided the students with two hours of training on effective marketing strategies. The Referral Marketing Officers made weekly visits to referral source offices and also participated in two health fairs during the 6-month period.

OUTCOMESWithin the trial period, the Clinic received 35 new clients. Five of the clients cancelled their first scheduled initial evaluation and were successfully rescheduled. Three clients cancelled and were never seen. The new clients came from 17 new referral sources. One referral source referred 6 clients. Three physicians referred 2 clients each. Four clients were referred by word-of-mouth from DPT students. Another 6 clients were return clients from a previous year. In a concluding reflection paper, The Referral Marketing Officers both stated that the experience built their confidence in marketing to referral sources and expect it to help them in their professional career.

DISCUSSIONThe Referral Marketing Officers came close to achieving their goal of 40 new clients with a total of 35 and three that cancelled or no-showed and were never seen. Perhaps more significantly, they more than tripled their goal of new referral sources with 17. In exceeding this objective, they opened up communication and relationship for potentially more referrals in the future. Marketing the Clinic has shown to benefit the Clinic, the students, the referral sources; and most importantly, the underserved and underinsured individuals in our community that benefit from the services the Clinic provides.

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Balancing Inclusion and Use of Outcomes Instruments in the Physical Therapy Outcomes Registry PRESENTED BYChesbrough K, Crockett R, Elrod M, Smith H, Irrgang JJ

PURPOSEPhysical Therapy Outcomes Registry (Registry) will utilize a select number of outcomes instruments. Through this, analytical power and strength of data will be maximized. PT Now, which provides access to tests and measures, lists 200 instruments available for use. Thus, it was necessary for Registry’s Scientific Advisory Panel (SAP) to develop a process to review instruments proposed for inclusion to ensure established criteria for inclusion is met.

DESCRIPTIONThe SAP created an Outcomes Instrument Inclusion Application (Application), replicating items from forms such as EDGE Taskforce Outcome Measure Rating Form, COSMIN Checklist, and APTA’s NOD Outcome Instrument Submission Form. This draft was distributed to APTA Academies and Sections and other stakeholders for feedback. SAP incorporated feedback and finalized Application. Application consists of a Pre-Application broken into three sections: Identifying Information for Submitting Organization, Identifying Information for Proposed Instrument, and Narrative; and Full Application consisting of: Specifications, Scientific Acceptability, Feasibility of Use, and Adoption of Proposed Instrument. An Application Review and Evaluation Form was created and draws from the NQF Measure Evaluation Criteria and Guidance Summary Tables. The form will summarize and evaluate applications in terms of instrument’s specifications, scientific acceptability, feasibility of use, and adoption.

SUMMARY OF USEStakeholder groups may utilize outcomes instruments specific to their specialty. As Registry encourages enrollment from all areas of practice, it should also have available instruments used by clinical specialties. A stakeholder representative will contact Registry to initiate an Application. Registry director will provide representative with a Pre-Application to collect initial information about proposed instrument. If Pre-Application meets baseline administrative threshold, representative will be provided with a link to full Application. Representative will provide requested information and submit full Application. A subgroup of the SAP will review Application and discuss instrument’s clinical objectives and scientific merits, balanced with needs of stakeholder as described in Application’s Narrative, and make a recommendation to SAP as to inclusion in Registry. The full SAP will then vote to approve the recommendation and director will notify stakeholder representative of decision.

IMPORTANCE TO MEMBERSThe Registry provides the best opportunity to develop a core set of measures to be used to assess effects of physical therapist management for patients since instruments available within Registry will be limited. However, in recognition of importance of clinical specialty, the SAP has developed a process to allow for instruments to be added, provided that instruments meet criteria for inclusion. This will balance the need for a limited number of instruments used to maximize data strength and power and the importance of allowing preferred instruments for specific areas of practice.

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Physical Therapy Outcomes Registry: A Multi-Dimensional Data Collection System PRESENTED BYChesbrough K, Crockett R, Elrod M, Smith H, Irrgang JJ

PURPOSEPhysical Therapy Outcomes Registry (Registry) is a unique, organized electronic data capture system that collects key variables representing PT practice across the continuum of care. It can evaluate process of care and clinical outcomes data to demonstrate value of care for population of patients receiving PT services. Collected data can be examined at patient, specific health condition, practice, organization and national levels. The Registry will provide a real-time source of comprehensive data that can be used in payment, research, practice, and quality exercises. Finally, the Registry is a CMS approved QCDR, allowing participation in the Merit-Based Incentive Payment System.

DESCRIPTIONRegistry Core Data Set (CDS) contains 70 data elements categorized into patient, episode, visit, and clinician/facility domains. Domains are patient-centric and captured for episode of care at each visit. Data variables were identified by an APTA Board of Directors’ Task Force to represent key elements of PT practice. A global measure of physical function and condition/population specific physical function outcomes measures are collected as part of CDS as well as a patient satisfaction score and quality reporting measures. APTA worked with Regenstrief Institute to assign unique Logical Observation Identifiers Names and Codes (LOINC) for CDS elements as part of data standardization process. The APTA Registry Panel was published in December 2015 with an update in July 2016. Outcomes tools will be limited to a select number to optimize power of data. Data elements pertaining to specific populations and interventions are currently under development and will be incorporated into Registry as available. The CDS in its entirety was reviewed and validated by Registry’s Scientific Advisory Panel. All areas of PT practice are eligible to participate. After a practice completes Registry’s online enrollment process, a representative of the technical vendor will work with practice administrator to install data collection software and monitor data flow over a 2- to 3-month period to ensure accuracy.

SUMMARY OF USERegistry is designed to allow for automatic and seamless data transmission from an EHR into Registry’s cloud-based platform. Registry’s CDS is mined from EHR and then either “pushed” or “pulled” into Registry. System integration begins with installation of a software interface, developed by Registry’s technical vendor, used to identify and extract Registry’s data fields. Any EHR system can be used in conjunction with Registry. A manual data entry interface is also available for users that do not use an EHR. Users are then able to generate benchmarking reports using their practice’s data as well as de-identified aggregate data from all sites enrolled.

IMPORTANCE TO MEMBERSRegistry is a platform for using data to inform practice, meet payment requirements, support quality improvement activities, and provide a robust data repository for research initiatives.

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Implementation of patient-centric, interdisciplinary virtual handoffs across the post-acute continuum PRESENTED BYKimberly Baasch

PURPOSETo a present a performance improvement initiative that promotes patient participation and interdisciplinary collaboration in the handoff process between post-acute settings. This process is designed to engage patients for improved activation, satisfaction, and safety.

DESCRIPTIONCurrent literature on patient handoff recommends standardizing a live, two-way dialogue that involves clinicians with extensive knowledge of the patient, as well as the patient, family and caregivers. This type of handoff is recommended at all levels of transition, though historically standardized call report has only been performed between nurses at overnight care settings.Aligned with these recommendations, a team of clinicians and administrators from a post-acute rehabilitation system designed a handoff process that utilizes live videoconference between the patient, their family, the primary nurse and a primary therapist at the sending facility, and the accepting nurse and therapist at the next setting. Anticipated benefits include increased patient activation, patient satisfaction, and patient safety.Patient activation is expected to improve by allowing patients to listen to and participate in their medical and rehabilitation reports and ask questions of the sending or receiving care teams. When patients are aware of their unique alerts, challenges, and goals they are better equipped to follow recommended plans of care and advocate for themselves.Patient satisfaction is projected to improve by reducing the anxiety associated with transitions to unfamiliar settings. This is achieved by introducing patients to members of their next care team and allowing them to ask questions and express concerns.Patient safety is anticipated to improve through the patient-centered and interdisciplinary nature of the virtual handoff by conveying a more comprehensive and relevant profile of the patient.Additionally, virtual handoffs are expected to connect care team members across various settings, fostering consultative practice and systems-based thinking.

SUMMARY OF USEThe virtual handoff process is being implemented across inpatient rehab, skilled nursing, home health, and outpatient and is indicated whenever a patient transitions between care settings within the system. An important part of the early success of this initiative has been identifying content experts to educate staff and coach them through live virtual handoffs. This allows for the coaches to consult with patients, families, and staff members on both sides of the handoff to further improve the process design.Key metrics that are being monitored are the Patient Activation Measure, patient satisfaction questions about care transitions, and rates of return to acute care from “downstream” settings.

IMPORTANCE TO MEMBERSThis process improvement initiative models an innovative way to improve continuity of care across settings, improve the transition process for patients, and enhance the patient-provider therapeutic alliance.

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National Fall Prevention Program in Trinidad and Tobago: A Collaborative Model PRESENTED BYNowakowski KA, Rauseo CM, Ottley CA, Pierre WM, Braga AJ, Fitzgerald EA, Levesque KF, Mulligan AE, Tomanio EA

PURPOSETo describe the creation and implementation of a collaborative model for a National Fall Prevention Program in Trinidad & Tobago (T&T). This model served as a program for creation of a sustainable national service and source of population data.

DESCRIPTIONThe program was a collaborative effort to address fall prevention in T&T between an academic institution and a physiotherapist from T&T, who is an alumna. Four physiotherapists with a vested interest (3 from T&T who are members of the Physiotherapy Association of Trinidad & Tobago (PATT) and a US faculty member who is Board Certified in Geriatric Physical Therapy) created the program structure. It included educational sessions provided by geriatric professionals and stations with measures to assess fall risk. Fall screening tools were adapted from the STEADI and included Timed Up and Go, Single Limb Stance and 30-sec Sit to Stand. These tools are readily available, have cutoff scores and normative values, and are used cross culturally and across socioeconomic and educational levels with clients in community screenings. Collaboration with the academic institution provided geriatric expertise and manpower to administer outcome measures. Five Doctor of Physical Therapy students enrolled in a Global Service Learning Course were trained in administration of screening tools. Physiotherapists in T&T did the pre-event groundwork including marketing, securing locations and speakers, recruiting manpower, logistics and transport. Ministry of Health/Ministry of Planning and Sustainable Development/Ministry of Social Development and Family Services provided busses, copying services and were present at all event locations. The program was held in 4 different locations within T&T over a span of 4 days.

SUMMARY OF USEA total of 345 older adults participated in the events. The high level of interest was a marker of the need to create a community program to address fall prevention. The program increased national dialogue about falls among physiotherapists and the PATT. Data collected will assist in marketing to larger sponsors, requesting support from government ministries and will provide background for a proposal to the national health agenda for vision 2020. Elements critical to program success were that it was free to participants, there was collaboration of professionals locally and globally, and the availability of government support. Limitations moving forward include funding, manpower, space and accessibility of event locations.

IMPORTANCE TO MEMBERSThis is an example of a community service program using a collaborative approach with a global partner. The program was used to assess interest, support need for national data collection, and identify means for a sustainable program. DPT students had an opportunity to be involved in a population level issue in an under-resourced country with a familiar health problem but in a different culture and environment. Program emphasized professional collaboration, social responsibility and role of physical therapy in primary prevention locally and globally.

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Pro Bono Clinic Management and Utilization within Physical Therapist Education Programs in the United States PRESENTED BYSteinbarger K, Morren KK, Goulet KA, Knecht S, Moscone M, Nicastro E

PURPOSE/HYPOTHESISThe purpose of this study was to describe the utilization and implementation of pro bono clinics in physical therapist educational programs within the United States. Data collected included the status of these pro bono clinics, such as structure, timing, space, faculty involvement, interprofessional collaboration, student management, and form of implementation into current program curricula.

NUMBER OF SUBJECTSAn electronic survey was distributed to 219 accredited physical therapist programs in the United States.

METHODS/MATERIALSA semi-structured, 25 question survey was electronically distributed through SurveyMonkey. Data from SurveyMonkey was entered into the Statistical Package for the Social Sciences(SPSS) version 22 software package for analysis.

RESULTSSixty-four surveys were returned, yielding a 29% response rate. Of the respondents, 7% were located in rural settings, 36% in suburban settings, and 57% in urban settings. The survey revealed 65% of the respondent DPT programs had a pro bono clinic, 8% were still in the planning stages of developing a pro bono clinic, and 23% did not have clinic. More than half of the respondents who had a clinic reported mandatory student participation as part of the curriculum. Of the programs with a pro bono clinic, 50% reported that students treated within an interdisciplinary team. Programs that reported operating a pro bono clinic for greater than six years found the experience to be valuable for both the students and community. For the programs who did not have a clinic, 74% reported faculty workload and time constraints to be the major limiting factors.

CONCLUSIONSThe data yielded five significant findings, and from these findings, three recommendations were made for those programs considering the development or expansion of a pro bono clinic. The first recommendation was to consider development of the clinic as an interprofessional student experience, incorporating disciplines in rehabilitation medicine, primary care, and behavioral health. The second was to structure the clinic so students treat as a patient centered, interdisciplinary team for every part of the patient experience. The final recommendation was for programs to strongly consider the value of the clinic experiences to their students and community, particularly when workload and time constraints emerged as a barrier to development.

CLINICAL RELEVANCEThe results of this study can be utilized to support the development or expansion of pro bono clinics affiliated with physical therapist programs across the country. Healthcare educators are recognizing the value of interprofessional, hands on experiences outside of traditional clinical education, and are looking for meaningful ways to incorporate these into their academic curricula. The recommendations from this study can provide guidance to programs looking to add a pro bono clinic experience to their students and community members.

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Leadership Education in Healthcare Professional Entry-Level Programs: A Review of the LiteraturePRESENTED BYThompson KA, Grix A, Stevenson A, Wideman M

PURPOSE/HYPOTHESISLeadership skills are important for healthcare practitioners and students should begin skill development during professional preparation. The purpose of this literature review was to describe the models, design, content, and characteristics of leadership education for students.

NUMBER OF SUBJECTSN/A

METHODS/MATERIALSThe keywords ”leadership”, “healthcare”, and “education” were used to search CINHAL, PubMed and Web of Science. Articles were then screened for the keywords in the title or abstract. Articles included after the initial screen were each reviewed by 2 researchers for the inclusion criteria: 1) described education related to leadership; 2) included entry-level health profession students; and 3) reported models, design, content, and characteristics of leadership education. Data was extracted, coded and entered into an excel spreadsheet: year of publication, country of study, profession, characteristics of the program, assessment method, and study design. Descriptive data collected: type of leadership model, objectives, content, barriers, effectiveness and study limitations. Frequencies were calculated and descriptive data was analyzed.

RESULTS2,404 articles were identified. 37 articles met inclusion criteria with the most frequent year of publication: 2014-2016 (57%); country of study: US (70%); and profession: nursing (43%). Program characteristics varied widely. Highest frequency for the following characteristics: program type: classroom learning (86%); duration: semester (46%); assessment method: survey (35%); study design: program evaluation (46%); type of leadership model: no model identified (57%); content: didactic (86%). The majority of programs were described as effective (89%) although less than half of the programs described improvements in leadership skills.

CONCLUSIONSThe majority of articles on leadership preparation for students were recent and were in nursing/medicine with smaller numbers in other health disciplines including physical therapy. The most frequent type of learning was classroom although many programs included experiential, clinical and/or service learning along with administrative or management activities. Program characteristics were very different and could not be fully described due to unclear or incomplete data. These results are consistent with previous literature that also found a lack of information and wide variation in program characteristics. Further research into the development of student leadership skills is required in order to support a theoretical approach for the assessment of leadership program efficacy and best practices.CLINICAL RELEVANCEWhile it is important for students to develop as healthcare leaders the research on leadership education is inconclusive. There are leadership resources and leaders in practice and professional organizations that might offer guidance and insight to programs. Conceptualizing a framework for the education, development and evaluation of student leadership will provide direction for graduates to continue the leadership journey as a healthcare professional.


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Advocacy and leadership skills developed through an innovative curriculum model PRESENTED BYJohnston LB, Sekerak D

PURPOSEEffective strategies for inspiring students to embrace personal professional responsibility for advocacy and leadership are needed. A focused curriculum embedded within a DPT program provides an opportunity for structured learning and active engagement in these areas. This unique curriculum structure and content provides students with exposure and opportunities designed to inspire future professional action. The purpose of this presentation is to describe a successful curriculum model that may be implemented in other academic programs in collaboration with local professional communities.

DESCRIPTIONA structured two-course professional issues sequence provides student opportunities to develop communication, collaboration and leadership skills as they build interprofessional coalitions, participate in advocacy situations, and develop relationships with policy makers and legislators. Relevant content is reinforced throughout the curriculum. Curricular themes include evidence-based opinion, multi-stakeholder analysis, active vs. passive decision making, shared responsibility, impact of action and inaction on the profession, as well as historical, contemporary and futuristic perspectives. Themes are integrated across a matrix of learning experiences which include reflective journals, on-line discussion forums, a PT/PTA panel discussion, a mock house of delegates, a legislative advocacy day as well as the development of a personal plan for continued competence and professional development. Effectiveness of this curriculum model is monitored by a systematic narrative review of 2nd and 3rd year student reflective journals, unprompted inclusion of leadership and advocacy activities in student professional development plans, and graduate and alumni activity survey responses related to leadership and advocacy. Three cohorts of DPT students will be described.

SUMMARY OF USEDPT programs often provide didactic instruction related to these important professional roles. This active learning/engagement model of simulated and real professional advocacy and leadership experiences in combination with didactic instruction in multi-stakeholder, evidence-based issue analysis promotes the development of enhanced appreciation and confidence in leadership and advocacy skills of new graduates and shows promise for increasing post-graduate professional involvement.

IMPORTANCE TO MEMBERSThe profession of physical therapy is dependent upon therapists’ active involvement in the profession and society, serving as leaders and advocates for their patients, the profession, and the community. Effective advocacy and leadership education may stimulate ongoing contributions to the profession and the communities served.

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Implementing Mobile Health Technology in the Patient-Centered Medically Oriented Gym setting to Activate Patients With Low Bone Mineral Density: A Feasibility Study PRESENTED BYFreeman L, Handt ML, Ochoa SL

PURPOSE/HYPOTHESISThe value of mobile health (mHealth) technologies for individuals at-risk for fracture such as older adults with osteopenia, sarcopenia and other chronic conditions has captured the attention of the population health stakeholder community. Forces that compress bone via impact activity can stimulate adaptive response of BMD growth beyond 4.2 MOB. Further, more rapid growth in BMD has been seen in magnitudes of loading beyond the minimum dose response of 4.2 MOB. The purpose of this study is to apply existing smartphone hardware via application to monitor and educate patients/clients and providers on the minimum dose response for multiple-of-bodyweight (MOB) compressive force osteogenic loading.


METHODS/MATERIALSTwenty patient/client or provider pairs from our Medically oriented gym. Eligible subjects were individuals, 45 years of age or older with multiple chornic conditions. Participants recieved a session in which there were trained to use a novel software application that allows impacts through the lower extremities to be recorded and examined has been developed for educational purposes. Instances of engaging in impact protocols, which include holding the smartphone against the hip joint while jumping and absorbing impact.

RESULTSTests showed 40 consistent results (20 heel and 20 hip) of 4.57MOB at the heel, and 2.91MOB at the hip (ANOVA p<0.0001).

CONCLUSIONSAs the accelerometer in a smart phone can be placed near the hip joint, a more accurate representation of loading into this joint can be seen with a simple Application and the standard Smart phone that many people have. Health systems anc ommunities are dedicating efforts to knowledge translation and quality improvement programs.This feasibility study provides preliminary evidence on whether patients and their caregivers can learn to effectively use a post dischargemonitoring smartphone app and assess patient and provider satisfaction. These data also reflect the known level of deceleration seen with the musculoskeletal system when reviewing the difference between heel and hip loading events.

CLINICAL RELEVANCEWe leveraged the alignment of national policy and gaps in adherence to dose-response to osteogenic adaptation to implement a patient-centered mHealth intervention focused on patient activation. The resulting application may be a cost-effective method for activating this population on their ability to generate bone mass increases with physical activity.

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Validation of Patient Satisfaction Measures in a Physical Therapy Clinic with a Vulnerable Population PRESENTED BYMilidonis MK, Keehan JG

PURPOSE/HYPOTHESISThe purpose of the study is to present preliminary analysis on the development and validation of a patient satisfaction with physical therapy care for vulnerable patients. Previous research identifies satisfaction is associated with professional interactions and individualized care and can improve treatment adherence. Patient satisfaction is considered to be multidimensional.

NUMBER OF SUBJECTSData were gathered from 106 adult participants who responded to 19 items regarding satisfaction with care. The patients sought physical therapy ambulatory care services at a pro bono clinic.

METHODS/MATERIALSThe items were modifications of items from Physical Therapy satisfaction and an individualized care scales. The validation consisted of three steps. First, a factor analysis of the 19 items was conducted to determine the factor structure. Second, analyses were conducted to examine the internal consistency and to strengthen the other psychometric properties of the scale. Third, as an initial assessment of validity the factor scores derived from the scales were used to predict patient reported outcomes.

RESULTSA principle components factor analysis with Varimax rotation was conducted, resulting in 5 factors with eigenvalues greater than 1. The interpretability of the factor as well as an examination of the scree plot led the investigators to conclude that a three factor solution was best. The three meaningful factors are: individualized care, professional interactions, and theraputic concerns. Items with factor loadings greater than .60 were used to select items for each of the final four scales representing the factors. Analyses of the internal consistency of these scales were then conducted. Patients were asked to respond to 5 questions regarding their therapy outcomes. As a preliminary test to the validity of the scale, factor scores were entered in a multiple regression analysis to predict each of the 5 outcome measures. The first three scales resulting from the factor analysis significantly predicted two of the patient outcome measures. Thirty three percent of the variance in overall satisfaction with the services of the therapist were predicted by individualized care, therapeutic concerns, and professional interactions..

CONCLUSIONSAnalysis of previously validated scales on patient satifaction and individualized care identified significant internal consistency and predictive validity. Individualized care, professional interactions and therapeutic concerns are important factors in physical therapy management of vulnerable populations. Understanding the needs of vulnerable populations may improve adherence to physical therapy treatment.

CLINICAL RELEVANCEProfessional patient centered interactions can engage all patients to become more confident in self managment. A patient’s perception of their physical therapy experience coupled with outcomes of care determines the value the value of the services received.

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Effect of a cross-cultural service-learning trip on the clinical cultural competency of physical therapist students PRESENTED BYSanko JP, Leininger PM, Wagner BR, Ross MD

PURPOSE/HYPOTHESISThe purpose of this study was to determine the effects of an extra-curricular cross-cultural service trip on the clinical cultural competency of physical therapist students. We hypothesized that participation in an extra-curricular cross-cultural service trip would positively influence the clinical cultural competency of physical therapist students.

NUMBER OF SUBJECTSThirteen physical therapist students from a single university, all of whom were in the professional phase of their educational program, participated in this study. Each of the students completed a week long service trip to the Navajo Indian Reservation in Window Rock, AZ. Pre-trip preparation and post-trip reflection activities were combined with service activities such as evaluating, treating, and counseling patients, quality improvement initiatives, and working as a member of an interdisciplinary health care team at a school for children with special needs and an Indian Health Services Hospital. An emphasis was placed on helping students understand how traditional Native American beliefs and spirituality complement modern medicine, including physical therapy, through personal experiences on the trip and insight from a traditional instructor and healing guide.

METHODS/MATERIALSPrior to and following their service trip, participants completed the Clinical Cultural Competency Questionnaire (CCCQ), which is a valid and reliable self-administered assessment instrument that measures different aspects of cultural competency in subscales assessing a health care provider’s knowledge, skills, attitudes, and situational awareness/encounters in cross-cultural environments. The items in the subscales of the CCCQ are assessed using a 5-point Likert scale. The total score for each subscale was obtained by summing the scores for each item in that subscale with scores compared prior to and following the student service trip with paired t-tests.

RESULTSSignificant increases were seen in the scores of each of the 4 subscales of the CCCQ, including physical therapist student knowledge (p=0.0003), skills (p=0.001), attitudes (p=0.004), and situational awareness/encounters in cross-cultural environments (p=0.001).

CONCLUSIONSStudents in this study paticipated in a structured service-learning experience at the Navajo Indian Reservation in Window Rock, AZ. The findings from this study support physical therapist educational program use of extra-curricular cross-cultural service-learning experiences to foster cultural competence in physical therapist students.

CLINICAL RELEVANCETraditional Native American beliefs, spirituality, and healing practices are not well-known outside the Native American community. This study demonstrated that extra-curricular cross-cultural service-learning experiences are of value as they impact and improve cultural competency.

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Implementation of a Pediatric Rehabilitation Program for Children with Disabilities in the Ecuadorian Amazon PRESENTED BYFalcone NM, CADENA A

PURPOSESupport the development of a self-sustainable pediatric rehabilitation program for children with disabilities within the existing healthcare system in the Napo Province of Ecuador.

DESCRIPTIONPersons with a disability in Ecuador account for 12.14% of the population. The Napo Province (pop 103,697) has 3,780 persons with a disability. The region is served by public Hospital Jose María Velasco Ibarra (JMVI). Following earlier volunteer work, it was established that there were no existing pediatric rehabilitation programs in the region. This global health initiative utilized a horizontal approach to address the service gap in services for children with a disability through the creation of a permanent rehabilitation institution.The PediHabilidad (PH) project was developed in 2006 by a US physical therapist to provide rehabilitation services to children from 0-12 years old at Hospital JMVI. PH trained Ecuadorian Physical Therapy students, staff and Community Based Rehabilitation workers. Durable medical equipment (DME) was shipped from the US, as well as fabricated by local workers. In coordination with local authorities, PH oversaw the design of a new clinic “Centro de Rehabilitación Integral” and the construction of an accessible playground. PH organized medical missions to address identified service gaps in Neurology (Centro International de Neurociencias), Pediatric Orthopedic Surgery (Metrofraternidad) and provide orthotics (Fundación Hermano Miguel). Funding for the project was obtained through grant awards and donations through Maidstone Foundation, Inc., a US 503 (c) non-profit, and local Ecuadorian institutions.

SUMMARY OF USEOver seven years, more than 500 children received physical, occupational and speech therapy at no cost. PH hosted 30 volunteer therapists from the US, Canada, and Europe. Services grew from an average 3.9 to 10.3 patients per day. Parent education was essential, as children from remote regions were seen only 1-2 times per month. The average patient was 1-4 years old (45%) with neurological impairment/developmental delay (59%) and lived in the rural area (46%). From 2009-2013, an average of approximately 150 patients were treated annually for Epilepsy during the Neurology Brigade. An estimated 94 units of DME and 129 orthotic braces were issued to children. “Centro de Rehabilitación Integral” transitioned to a permanent department staffed by 5 therapists and administered by Hospital JMVI.

IMPORTANCE TO MEMBERSCollaboration and long term planning with the existing public healthcare system as well as training of Ecuadorian staff, students and caregivers were imperative in ensuring the success and sustainability of the project. Environmental barriers and cost impeded the use of standard DME. This project demonstrated the need to construct adaptive equipment with limited resources suited to a rural environment. Limitations include the lack of a formal outcomes study and establishment of an official relationship between the US-based institution and Hospital JMVI to guide ongoing involvement.

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Moderating effects of cognitive-behavioral variables on the effectiveness of two different long-term web-based weight loss interventions among women living in rural underserved areas PRESENTED BYHageman PA, Kupzyk KA, Yoerger M, Pullen CH, Eisenhauer CM, Pozehl B

PURPOSE/HYPOTHESISThis secondary analysis from a randomized controlled trial investigated the moderators of effectiveness of two weight loss interventions, either web-based with peer-led discussion (WD) or web-based with professional email counseling (WE), on body weight over 30 months in women from rural communities who have high risk for obesity-related comorbidities and limited access to weight loss counseling. As both groups achieved similar reductions in body weight over time, we sought to determine whether the variability in trends over time within groups could be explained by specific moderating effects of individual perceptions of cognitive-behavioral constructs.

NUMBER OF SUBJECTSTwo-hundred women participated (baseline age 53.4 ± 6.7; weight 207.0 ± 28.2 lbs).

METHODS/MATERIALSWomen were randomly assigned to WD (n=100) or WE intervention groups (n=100), designed by an interprofessional team of a physical therapist, nurses and a dietitian, to promote healthy eating and activity with primary outcomes of weight change. Weight was collected at baseline, 3, 6, 12, 18, 24, and 30 months. Moderators included demographic and cognitive-behavior variables (benefits and barriers to and self-efficacy for healthy eating and activity, depression and fatigue) using validated survey instruments. Longitudinal multilevel models, which use maximum likelihood estimation to utilize all available data, were used for analyses of moderators for WD and WE outcomes.

RESULTSAt 30-months, no differences in weight loss were observed between groups (average weight loss at 6 lbs). However, we observed significant moderation effects of the two groups. Women within the WE group who were more successful at weight reduction had lower perceptions of barriers to and higher self-efficacy for healthy eating and activity, and lower levels of depression and fatigue at baseline. In contrast, women who appeared more responsive to the WD intervention to achieve weight loss perceived more barriers to and had lower self-efficacy for healthy eating and activity, and higher levels of depression and fatigue at baseline.

CONCLUSIONSAlthough women in two different web-based weight loss interventions (WD and WE) achieved similar weight loss over 30 months, cognitive-behavioral variables moderated group effects, suggesting there were differences in women’s responsiveness to the interventions based on individual traits.

CLINICAL RELEVANCEPhysical therapists are actively involved in behavior-change interventions, including health promotion efforts for weight loss using web-based technologies to reach rural populations. The majority of web-based weight loss studies focus on change in bodyweight over time. Few studies examine whether certain cognitive-behavioral variables affect an individual’s responsiveness to specific interventions. Increasing the awareness about and research towards understanding moderating effects that enhance specific web-delivered behavior-change intervention effects is warranted.

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Mobile technology to support home exercise for people with arthritis: A qualitative study of patient and physical therapist perspectives PRESENTED BYSmith P, Liebman B

PURPOSE/HYPOTHESISOsteoarthritis (OA) is the most common cause of disability worldwide. Physical therapist-directed exercises are evidence-based treatment to improve pain and disability outcomes, but adherence with home exercise is low. Recent technology products such as mobile applications (apps) offer the potential to enhance communication between physical therapists and patients while addressing common barriers to exercise among those with OA. The purpose of this study was to examine patients’ and providers’ perspectives on mobile apps to support physical therapist prescribed home exercise.

NUMBER OF SUBJECTS18 physical therapists (83% female; mean experience = 16 years) and 17 individuals with a history of physical therapy for OA (77% female; mean age = 64 years). Subjects were recruited through clinics and community postings.

METHODS/MATERIALSFocus groups (n=6, three each with physical therapists and patients) were conducted to gather perspectives on three commercially available mobile apps designed for physical therapy exercise prescription. Semi-structured questions, based on published literature and researcher expertise, assessed feature preferences, ease of use, exercise adherence support, feasibility of use in clinical practice, and barriers and facilitators to using the apps. All discussions were audio-recorded and transcribed. The study team iteratively coded transcripts using thematic analysis. Key themes were defined and then refined using the ‘4 Rehab Communication Elements’ model

RESULTSPatients’ and therapists’ perspectives intersected but differed on the mobile apps. All patients preferred video exercise prescription over traditional methods and both, patients and therapists, predicted challenges and opportunities with mobile communication. Four themes emerged: Accountability, Data-driven, Chit-chat, and Duality of Technology. Facilitators of home exercise through mobile apps included exercise tracking, feedback loop, options to personalize, and potential for reduced in-person visits. Barriers included technological challenges, complex interface design, lack of universal applicability, and security concerns.

CONCLUSIONSThere was a consensus among patients with OA for exercise prescription preference through mobile apps over paper handouts. Yet, thematic analysis revealed potential for improved communication as the main driving factor over technological aspects of the apps. While physical therapists identified potential to improve the rehabilitation experience with mobile apps, there was concern about reimbursement and time constraints in the current fee-for-service environment. Emerging themes from the discussions related to theoretical constructs of supportive relationship, effective information exchange, and shared action planning.

CLINICAL RELEVANCERecent trends in mobile app technology have the potential to support exercise adherence for people with OA. However, patients’ and therapists’ perspectives differ and bring numerous challenges that limit universal clinical adoption of this technology.

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An Increased Number of Medicaid Beneficiaries Utilized Ambulatory Physical and Occupational Therapy Services in the First Year After Medicaid Expansion PRESENTED BYRobert Sandstrom

PURPOSE/HYPOTHESISThe purpose of this study was to determine the change in utilization of ambulatory physical and occupational therapy services by Medicaid beneficiaries after Medicaid expansion. The experimental hypothesis was that ambulatory therapy utilization would increase at the population- level (number of beneficiaries and total national expense) and the beneficiary level (annual number of visits and expense) in 2014, the first year of Medicaid expansion, vs. 2013. The null hypothesis was that there would be no change in utilization at the population or beneficiary levels.

NUMBER OF SUBJECTS197 observations from the 2013 and 232 observations from the 2014 Medical Expenditure Panel Survey (MEPS) were studied. Each observation represented a Medicaid beneficiary with an annual therapy expense.

METHODS/MATERIALSPopulation estimates and standard errors of the estimates were determined for the study variables in each study year. MEPS variables of the annual number of therapy visits and annual therapy expense for Medicaid beneficiaries were used in the analysis. Prior to analysis, the survey design was declared in STATA 14. To determine the number of patients, a dummy variable identifying a marker for each Medicaid beneficiary with a therapy expense was created. The total number of patients (markers) was then calculated. An estimate of the total Medicaid expense for ambulatory therapy services was calculated. Similarly, the mean number of annual visits and annual expense estimates for Medicaid ambulatory therapy patients were determined. Population estimates were accepted if the relative standard error of the estimate was < 30%. The statistical signficance of a difference between the 2013 and 2014 population estimates was determined using the t- test, p<.05.

RESULTSThe relative standard error of the population estimates was <= 21%. An increased number of Medicaid beneficiaries utilized ambulatory therapy services in the first year after expansion (1.73 million persons in 2014 vs. 1.29 million persons in 2014, p=.04). Differences in total Medicaid expense ($2.42 billion in 2013 vs. $4.01 billion in 2014, p= .11), mean annual number of visits (13.02 visits in 2013 vs. 14.01 visits in 2014, p=.73) and mean annual patient expense ($1870 in 2013 vs. $2324 in 2014, p= .45) were not statistically significant.

CONCLUSIONSA 44% increase in the number of Medicaid beneficiaries utilizing ambulatory therapy services was observed in the first year of Medicaid expansion. A larger sample size may be needed to determine the effect of this growth on program expense and per- patient utilization in Medicaid.

CLINICAL RELEVANCEPhysical therapists in an ambulatory therapy setting are serving a higher number of low income persons since Medicaid expansion.

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Predictors of discharge settings following total knee arthroplasty in Medicare patients PRESENTED BYWelsh R, Graham JE, Karmarkar AM, Leland NE, Baillargeon JG, Wild D, Ottenbacher KJ

PURPOSE/HYPOTHESISTotal knee arthroplasty (TKA) is one of the most common surgical procedures performed in the United States with tremendous growth expected. Policy changes have impacted post-acute discharge settings following TKA. We examined the factors associated with post-hospital discharge of Medicare patients to the three most common settings following TKA: inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and directly back to the community.

NUMBER OF SUBJECTSN=1,189,286

METHODS/MATERIALSRetrospective analysis of the 100% Medicare Part A data files from 2009-2011. We used multinomial logistic regression to model the odds of discharge to the three main post-acute settings.

RESULTSApproximately 57% of patients were discharged to the community, 32% received SNF and 11% received IRF. The following results are reported as odds ratios and 95% confidence intervals (OR, lower-upper) using IRF discharge as the reference. Males had lower odds of SNF discharge (0.86, 0.85-0.87) and higher odds of community discharge (1.24, 1.23-1.26) than females. Compared to white patients, racial/ethnic minority patients had lower odds of both SNF (0.97, 0.95-0.98 for black and Hispanic) and community (black: 0.76, 0.75-0.78; Hispanic: 0.89, 0.87-0.91) discharge. Patients with bilateral TKA had much lower odds of either SNF (0.46, 0.45-0.47) or Community (0.27, 0.26-0.27) discharge compared to patients with unilateral TKA. Compared to patients with no Charlson comorbidities, those with two or more conditions had higher odds for SNF discharge (1.06, 1.04-1.08) and lower odds for community discharge (0.79, 0.78-0.81). Lastly, compared to patients in the highest hospital-volume quartile, those in the lowest quartile had lower odds of SNF discharge (0.95, 0.92-0.99) and those in the middle two quartiles had lower odds of community discharge (0.90, 0.89-0.91 and 0.92, 0.90-0.93).

CONCLUSIONSThere is a lot of interest in comparing the effectiveness of different post-acute settings and in determining the optimal setting following TKA. Our results show substantial and likely purposeful differences in clinical populations across the three most common discharge settings. Care must be taken when comparing outcomes across these dissimilar populations.

CLINICAL RELEVANCEThese findings can be useful for healthcare practitioners, hospital administrators, payers, and patients better understand which patient or clinical factors influence post-acute settings following TKA. This study enhances the ability to more accurately predict which type of post-acute settings are typically used following TKA in the Medicare population using several important demographic and clinical variables

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The role of social media and its effect on adherence in physical therapy care: A systematic review PRESENTED BYMalta SL, Carpenter CM, Kenealy S, Reynolds J, Sotherden

PURPOSE/HYPOTHESISBehavioral modification is widely utilized by psychologists and mental health professionals to encourage lifestyle changes and influence preferred patterns of behavior to improve quality of life (QOL). Traditional physical therapy practice does not typically include motivational interventions (MI) to influence adherence, even though communication style and the adoption of a patient centered approach by healthcare professionals is known to influence motivation and behaviors.The purpose of this study was to examine the current literature regarding the role of social media and its effect on adherence in physical therapy care.

NUMBER OF SUBJECTSThe search identified 57 eligible articles, of which 7 studies were included.

METHODS/MATERIALSData Sources: A literature search of PubMed, Medline, Google Scholar, PsycInfo, EBSCO (CINAHL and GOVT), National Guidelines Clearinghouse and WorldCat using keywords and subject titles.Study Selection: Standard protocol using studies published from January 2011 through January 2017 in peer reviewed articles in the English language. Randomized control trials, pilot study and repeated measure designs with focus on motivational interventions that influenced exercise were included. The search identified 57 eligible articles, of which 7 studies were included.Data Extraction: Data extraction was performed independently by 4 researchers, with data then condensed and synthesized into one final summary table.Methodological Quality: Critical appraisal of studies was completed using the PEDro Scale. For any study earning a score less than 6 on PEDro, the 12-item Cochrane Collaboration’s tool for assessing risk of bias was applied for further evaluation.

RESULTSSeven studies were selected for this review that address physical activity, adherence, and social media. Three studies addressed pathologies of the musculoskeletal system, two of vascular disorders, one of metabolic disorders, one of high risk for falls and one of a healthy population. Four of the seven studies were randomized control trials. The mean ages for the populations of this review ranged from 25 - 76 years of age. Four of the seven studies stated improvements in adherence to home programs due to the use of social media.

CONCLUSIONSThe results of this systematic review point to a need for further research on the role social media has on adherence to physical therapy interventions. The optimal type of social media intervention and prescribed length of time has not yet been identified in the emerging literature. This supplemental tool is an easy, low cost option for physical therapists to promote health and wellness outside the clinic doors while developing patient’s self-efficacy and autonomy with exercise regimens.

CLINICAL RELEVANCEWith the help of social media, motivational interventions have the potential to augment traditional therapy interventions to enhance outcomes and improve quality of life.

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Utilizing a Quality of Life Measure to Improve Patient Satisfaction in Inpatient Rehabilitation for Patients with Acquired Brain Injury PRESENTED BYWindler S, Rankel E, Bienstock JB

PURPOSEThe purpose of this project is to determine if using a quality of life measure with patients and their families can:1. Help improve patient satisfaction in the areas of ‘Participating in Setting PT Goals’ and ‘How Well PT Helped Meet Goals’ as reflected by Press Ganey scores2. Enhance their experience and the experience of the physical therapist in reflecting on goals and progress made during inpatient rehabilitation

DESCRIPTIONAs healthcare continues to change and length of stay becomes shorter for patients with acquired brain injury (ABI) in inpatient rehab, it is harder for patients to meet their self-stated goals. At our facility, physical therapists engage in discussion about setting realistic, achievable and salient goals early and often. Despite their efforts, patient satisfaction scores on Press-Ganey surveys have been near or below the medical center’s benchmark of 80% in the areas of ‘Participating in Setting PT Goals’ and ‘How Well PT Helped Meet Goals’ for patients with ABI. Quality of life measures can be used to help patients identify progress after an ABI and help to improve patient satisfaction. The quality of life measure chosen to assist in reflecting on progress towards goals is the Global Rating of Change Scale (GRC), which is used to quantify improvement or deterioration over time. This scale is more often used in the outpatient orthopedic setting but the question has been individualized for use with the ABI population in the acute inpatient rehabilitation setting. After implementation of the GRC, Press-Ganey scores were analyzed and compared to scores from previous years.

SUMMARY OF USEPhysical therapists on the inpatient adult rehabilitation unit administered the GRC in conjunction with discussion of goals for 47 patients with ABI. If the patient was unable to complete the GRC due to cognitive or language impairments, family members were asked to complete the scale. The 17 Press-Ganey patient satisfaction surveys were analyzed in the areas of ‘Participating in Setting PT Goals’ and ‘How Well PT Helped Meet Goals’. This data was compared to Press-Ganey results up to 4 years prior to implementation of the scale. The data shows an improvement in Press-Ganey patient satisfaction in both categories since implementation of GRC with 94% satisfaction in ‘Participating in Setting PT goals’ and 90% satisfaction in ‘How Well PT Helped Meet Goals’ during the first quarter of 2017. Based on results of the GRC, patients perceive that their mobility has improved since admission to inpatient rehabilitation.

IMPORTANCE TO MEMBERSThese findings suggest that implementation of a quality of life measure in conjunction with reflection on goals can help improve patient satisfaction among patients with brain injury and their families. This can then enhance their experience by encouraging them to identify progress made during inpatient rehabilitation. In turn, this can help healthcare organizations improve their quality of care and reputation through its effects on Press-Ganey scores.

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Planting Seeds of Diversity, Equity, and Inclusion through Brain Games PRESENTED BYKlappa SG, DeLorm P, Alles Y, Blatt S, Sattgast J

PURPOSE/HYPOTHESISOrganizations, think tanks, and policymakers have explored the growing diversity gap among health care providers at levels of the health care system. Planting seeds of career possibility in K-12 education is one long-term solution to address diversity, equity, and inclusion in health care. The purpose of this study was to investigate the knowledge of fifth grade and high school students from Michigan schools with diverse populations per NICHE ratings with regard to the role of physical therapy (PT) practice after engaging in four “Brain Game” lessons on the roles of physical therapists in society.Research Questions:1. What do Brain Games teach fifth-grader and high school students about Physical Therapy?2. Do Brain Game experiences lead to improved understanding of the role of physical therapists in society?3. What strategies do students who engage in the Brain Games program articulate about becoming a physical therapist?

NUMBER OF SUBJECTS75 fifth grade and 75 high school students from schools in western Michigan with high diversity rates.

METHODS/MATERIALSThis project incorporated qualitative methods from Scholarship of Teaching and Learning (SoTL) to assess what fifth graders and high school students learned about PT through a community-based educational program on Brain Games teaching about the brain and roles of physical therapists in society. Educational sessions consisted of a description of PT practice and requirements for PT programs, discussions on treatment interventions, and case examples of simulated neurological injuries. Participants wrote about lessons learned from presentations on sticky notes collected on a poster board at the end of each session. Researchers independently analyzed data regarding lessons learned for common themes that emerged from the writings of the participants.

RESULTSQualitative methods revealed what fifth graders and high school students learned from, with, and about physical therapists. Four themes emerged from the data: 1) Who physical therapists are; 2) What physical therapists do; 3) Understanding the role of PT in society; and 4) What to do to become a physical therapist. The fifth grade and high school students reported learning about a new possibility for a future profession in physical therapy. Students were able to articulate what physical therapists do and what requirements are for entering PT school.

CONCLUSIONSCommunity-based educational sessions for fifth graders and high school students improved knowledge of the physical therapy profession. SoTL is often used in higher education to evaluate success of curriculum and instruction of professional programs. It may also be used to assess community-based education about the health professions.

CLINICAL RELEVANCELearning about, from, and with each other will help build awareness of the physical therapy profession and increase diversity, equity, and inclusion within the physical therapy profession. If there is no exposure to the physical therapy profession, K-12 students from diverse backgrounds may lack an awareness of the possibilities for a future career in physical therapy.

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DPT Student experiences with error reporting during clinical education PRESENTED BYStruessel T, Van Zytveld CR

PURPOSE/HYPOTHESISSome preliminary data is available on patient safety and error reporting in other health professions students, including medicine, pharmacy, and nursing. However, no research is available on patient safety experiences of physical therapy students in the clinic. The purpose of this project is to describe student experiences with error reporting during clinical education.

NUMBER OF SUBJECTS64 of 70 2nd year DPT students at a large public research university who had completed 5 of 7 academic semesters

METHODS/MATERIALSAs part of a larger descriptive study on patient safety in physical therapist education, an online survey was developed using the patient safety risk factors previously identified by the Institute for Healthcare Improvement. IRB approval was obtained. DPT students completed an anonymous survey via Survey Monkey immediately following a 10 week clinical rotation. Rotations occurred in various clinical settings (outpatient, inpatient, home health, pediatrics) across multiple states.

RESULTS100% of students reported feeling comfortable reporting an error to their clinical instructors. However, 19% either were not sure about any adverse impact on their clinical experience, or felt it would indeed be adversely impacted. 31% were not aware of a method to report error, and 57% did not observe other therapists or staff members reporting an error. 43% of students reported an error themselves. Of that 43%, 35% reported that no one in the facility followed up on the error they reported, and 90% reported no change in the facility after an error was reported.

CONCLUSIONSError occurs in healthcare settings, including those in which physical therapists practice, because error is inevitable due to human interactions in complex environments. While error is inevitable, patient harm usually results from a combination of underlying system conditions and human error. The first step in error reduction is recognition of, and open reporting of error. Students are immersed in healthcare systems during clinical rotations, but may not be educated on, or comfortable with error reporting processes (if they exist.)In this survey, while 100% of students reported feeling comfortable reporting error to their CI’s, 1/3 were not aware of any formal reporting system within their institution. In addition, 19% either thought it would adversely impact their clinical, or they were not sure if it would, which may create a barrier to student’s reporting error when it occurs. While 43% reported some sort of error, few reported any system change that occurred as a result. In addition, a third reported no follow up after reporting an error, suggesting a lack of system processes to reduce error recurrence.

CLINICAL RELEVANCEA lack of understanding amongst students and clinical instructors about the importance of error identification and reporting may put patients at risk for harm.

Documents

HPA The Catalyst · 2018-04-04 · 1.2 million Home Care Aides (HCAs) provide care nationwide to older adults. This job is marked by high rates of strain, turnover, and HCAs report