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In 2018, I wrote about 'canaries in the health care coal mines,' urging transformational change for a health care system that may be causing moral injury and burnout in our [...]

Artificial intelligence (AI) technologies are not new to scientific publishing. AI tools have long been available to assist authors with writing, grammar, language, references, statistical analysis, and reporting standards. Editors [...]

In August, I had my first personal encounter with a SARS-CoV-2 infection and was very fortunate to experience only mild symptoms, which I credit to being vaccinated and double boosted. [...]

Background. The World Health Organization recognizes participation in meaningful life roles as a key component of health. However, the evidence base for interventions to improve participation remains inconclusive. In particular, [...]

Journal editors devote a considerable amount of time to evaluating the technical quality of the design and conduct of our colleagues' research, along with assessing the potential impact the research [...]

Despite the commonly held belief that the US health care system is the best in the world, we face significant unmet health care challenges in the United States. A recent [...]

People with disabilities who use wheelchairs experience several burdens that can make air travel inconvenient, uncomfortable, and unsafe. The transfer at the gate to and from the boarding chair can [...]

As editor-in-chief of PTJ: Physical Therapy & Rehabilitation Journal (PTJ), I enthusiastically encouraged Dr Shirley Sahrmann to publish her Point of View (1) on the development and use of profession-specific [...]

Background. Adequate and user-friendly instalments for assessing physical function and disability in older adults are vital for estimating and predicting health care needs in clinical practice. The Late-Life Function and Disability Instrument Computer Adaptive Test (LLFDICAT) is a promising instrument for assessing physical function and disability in gerontology research and clinical practice. Objective. The aims of this study were: (1) to translate the LLFDI-CAT to the Dutch language and (2) to investigate its validity and reliability in a sample of older adults who spoke Dutch and dwelled in the community. Design. For the assessment of validity of the LLFDI-CAT, a cross-sectional design was used. To assess reliability, measurement of the LLFDI-CAT was repeated in the same sample. Methods. The item bank of the LLFDI-CAT was translated with a forward-backward procedure. A sample of 54 older adults completed the LLFDI-CAT, World Health Organization Disability Assessment Schedule 2.0, RAND 36-Item Short-Form Health Survey physical functioning scale (10 items), and 10-Meter Walk Test. The LLFDI-CAT was repeated in 2 to 8 days (mean=4.5 days). Pearson's r and the intraclass correlation coefficient (ICC) (2,1) were calculated to assess validity, group-level reliability, and participant-level reliability. Results. A correlation of .74 for the LLFDI-CAT function scale and the RAND 36-Item Short-Form Health Survey physical functioning scale (10 items) was found. The correlations of the LLFDI-CAT disability scale with the World Health Organization Disability Assessment Schedule 2.0 and the 10-Meter Walk Test were -.57 and -.53, respectively. The ICC (2,1) of the LLFDI-CAT function scale was .84, with a group-level reliability score of .85. The ICC (2,1) of the LLFDI-CAT disability scale was .76, with a group-level reliability score of .81. Limitations. The high percentage of women in the study and the exclusion of older adults with recent joint replacement or hospitalization limit the generalizability of the results. Conclusions. The Dutch LLFDI-CAT showed strong validity and high reliability when used to assess physical function and disability in older adults dwelling in the community., Adequate assessment of physical function and disability in older adults dwelling in the community is vital for estimating and predicting health care needs in research and clinical practice. (1,2) As [...]

Background. The Centers for Medicare & Medicaid Services has mandated rehabilitation professionals to document patients' impairment levels. There is no evidence of responsiveness to change of functional limitation severity modifier codes. Objective. The purpose of this study was to assess the validity of G-code functional limitation severity modifier codes in determining change in function. Design. This was a retrospective observational study. Methods. Patients completed the Activity Measure for Post-Acute Care (AM-PAC) and were assigned G-codes, with severity modifiers based on AM-PAC scores at initial and follow-up visits. Patients were classified as having AM-PAC scores in the upper or lower range for each severity modifier, and sensitivity, specificity, and positive and negative predictive values for change in severity modifier level and odds of changing by one severity modifier level using a change in AM-PAC score of at least 1 minimal detectable change at the 95% confidence interval ([MDC.sub.95]) as the standard were determined. Results. Sensitivity and specificity of change in severity modifier in determining change in function were dependent on patients' initial AM-PAC scores. Improvement in severity modifier level was 2.2 to 4.5 times more likely with scores at the higher end of the range within a severity modifier level than with scores in the lower end of the range. Decline in severity modifier level was 2.7 to 4.8 times more likely with scores at the lower end of the range within a severity modifier than with scores in the higher end of the range. Limitations. Data were from one health care system, and most patients had orthopedic conditions. The [MDC.sub.95] for AM-PAC tool may not be the best standard for defining functional change. Conclusions. The G-code functional limitation severity modifier system may not be valid for determining change in function and is not recommended for determining if patients have changed over the course of outpatient therapy., Physical therapists have long been encouraged to use well-tested, relevant standardized measures to assess patients' function and progress. Application of standardized measures enhances the ability of therapists to target interventions [...]

In the context of the global spread of the COVID-19 pandemic, health care services have had to adapt to provide safe delivery of care, limiting what some view as 'nonessential' [...]

Background. The interrater reliability of 2 new inpatient functional short-form measures, Activity Measure for Post-Acute Care (AM-PAC) '6-Clicks' basic mobility and daily activity scores, has yet to be established. Objective. The purpose of this study was to examine the interrater reliability of AM-PAC '6-Clicks' measures. Design. A prospective observational study was conducted. Methods. Four pairs of physical therapists rated basic mobility and 4 pairs of occupational therapists rated daily activity of patients in 1 of 4 hospital services. One therapist in a pair was the primary therapist directing the assessment while the other therapist observed. Each therapist was unaware of the other's AM-PAC '6-Clicks' scores. Reliability was assessed with intraclass correlation coefficients (ICCs), Bland-Altman plots, and weighted kappa. Results. The ICCs for the overall reliability of basic mobility and daily activity were .849 (95% confidence interval [Cl] = .784, .895) and .783 (95% CI=.696, .847), respectively. The ICCs for the reliability of each pair of raters ranged from .581 (95% CI=.260, .789) to .960 (95% CI=.897, .983) for basic mobility and .316 (95% CI= -.061, .611) to .907 (95% CI=.801, .958) for daily activity. The weighted kappa values for item agreement ranged from .492 (95% CI=.382, .601) to .712 (95% CI=.607, .816) for basic mobility and .251 (95% CI=.057, .445) to .751 (95% CI=.653, .848) for daily activity. Mean differences between raters' scores were near zero. Limitations. Raters were from one health system. Each pair of raters assessed different patients in different services. Conclusions. The ICCs for AM-PAC '6-Clicks' total scores were very high. Levels of agreement varied across pairs of raters, from large to nearly perfect for physical therapists and from moderate to nearly perfect for occupational therapists. Levels of agreement for individual item scores ranged from small to very large., A relatively high proportion of patients in acute care hospitals have mobility and self-care limitations. (1) A primary focus for physical therapists and occupational therapists based in hospitals is the [...]

The recently published clinical practice guideline (CPG) for physical therapist management of patients with total knee replacement (TKA) highlights limitations in the quality of existing evidence that impact the ability [...]

In an earlier PTJ editorial, I wrote about the dual challenges of overcoming ignorance and ineptitude in 21st century rehabilitation practice. (1) I defined ignorance as a limited understanding of [...]

At a conference, I had the privilege of listening to a talk by Dr Bell and Dr Earland from Thomas Jefferson University (Philadelphia, PA, USA) on the health care needs [...]

We are living in an extraordinary period of history, one that is creating enormous challenges and stresses for the health care professions, including physical therapy and other rehabilitation professions. As [...]

Previous studies have identified incomplete descriptions of interventions as a pressing problem in the reporting of randomized controlled clinical trials (RCTs) in the field of rehabilitation. (1-3) Rehabilitation is a [...]

Published in this issue of PTJ, 'Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure' (1) highlights that evidence-based guidelines for physical rehabilitation are increasingly important, [...]

Recently I received an email from an intern at a pharmaceutical company asking me to complete a survey about virtual clinical trials. In thinking about this request, I realized that [...]

Background. Physical therapists and occupational therapists practicing in acute care hospitals play a crucial role in discharge planning. A standardized assessment of patients' function could be useful for discharge recommendations. Objectives. The study objective was to determine the accuracy of '6-Clicks' basic mobility and daily activity measures for predicting discharge from an acute care hospital to a home or institutional setting. Design. The study was retrospective and observational. Methods. '6-Clicks' scores obtained at initial visits by physical therapists or occupational therapists and patients' discharge destinations were used to develop and validate receiver operating characteristic curves for predicting discharge destination. Positive predictive values (PPV), negative predictive values (NPV), and likelihood ratios were calculated. Results. Areas under the receiver operating characteristic curves for basic mobility scores were 0.857 (95% confidence interval [Cl] =0.852, 0.862) and 0.855 (95% 0= 0.850, 0.860) in development and validation samples, respectively. Areas under the curves for daily activity scores were 0.846 (95% 0= 0.841, 0.851) and 0.845 (95% 0=0.840, 0.850) in development and validation samples, respectively. Cutoff scores providing the best accuracy for determining discharge destination were 42.9 for basic mobility and 39.4 for daily activity. For basic mobility, the PPV was 0.748 and the NPV was 0.801 in both development and validation samples. For daily activity, the PPVs were 0.787 and 0.784 and the NPVs were 0.748 and 0.746 in development and validation samples, respectively. Limitations. Limitations included lack of information on the rater reliability of '6-Clicks' instruments, use of surrogate data for some discharge designations, and use of a clinical database for research purposes. Conclusions. This study provides evidence of the accuracy of '6-Clicks' scores for predicting destination after discharge from an acute care hospital., In acute care hospitals, many patients with neurological, musculoskeletal, and cardiopulmonary problems have limitations in walking and moving, self-care, changing and maintaining body positions, or several of these tasks. (1) [...]

Background. Standardized assessment of patients' activity limitations in acute care settings can provide valuable information. Existing measures have not been widely implemented. Objectives. The aim of this study was to provide evidence for validity of scores on Activity Measure for Post-Acute Care (AM-PAC) '6-Clicks' measures of basic mobility and daily activity in acute care. Design. A retrospective measurement study was conducted. Methods. The study used a database from one health system containing '6-Clicks' scores from first and last physical therapist and occupational therapist visits for 84,446 patients. Validity was analyzed by examining differences in '6-Clicks' scores across categories of patient characteristics; the ability of '6-Clicks' scores to predict patients' having more than one therapy visit; correlation of '6-Clicks' scores with Functional Independence Measure (FIM) scores; and internal responsiveness over the episode of care. Internal consistency reliability also was determined. Results. The '6-Clicks' scores differed across patients' age, preadmission living situation, and number of therapy visits. The areas under receiver operating characteristic curves derived using '6-Clicks' scores at the first visit to predict patients receiving more than one visit were 0.703 and 0.652 using basic mobility and daily activity scores, respectively. The '6-Clicks' scores at the final visit were correlated with scores on subscales of the FIM completed on admission to inpatient rehabilitation facilities (r=.65 and .69). Standardized response means were 1.06 and 0.95 and minimal detectable changes with 90% confidence level ([MDC.sub.90]) were 4.72 and 5.49 for basic mobility and daily activity scores, respectively. Internal consistency reliability of basic mobility and daily activity scores was .96 and .91, respectively. Limitations. Using clinical databases for research purposes has limitations, including missing data, misclassifications, and selection bias. Rater reliability is not known. Conclusions. This study provides evidence for the validity of '6-Clicks' scores for assessing patients' activity limitations in acute care settings., In the acute care setting, the case mix index of hospitals provides a means to measure the medical complexity and burden of illness for the patients they serve and the [...]

Background. Psychometric limitations of balance measures for community-dwelling elderly may be related to gaps in task and environmental representation. Objective. The purposes of this study were: (1) to conduct item-level content analysis of balance measures for community-dwelling elderly people based on task and environmental factors and (2) to develop profiles of individual measures summarizing their task and environment representation. Design. A systematic content analysis was conducted. Methods. A literature search was conducted to identify balance measures. Item- level content analysis was based on 7 criteria related to task and environment: (1) task role, (2) environmental variation, (3) object interaction, (4) obstacle negotiation, (5) external forces, (6) dual-tasking, and (7) moving people or objects in the environment. Results. Twenty-six measures, containing 167 items, were identified. Task role was fairly evenly distributed, with the majority of items examining gait tasks (32.3%), followed by dynamic body stability (29.9%) and static body stability (25.1%). The majority of items involved no environmental variation (58.1%), followed by variation of support surfaces (20.4%), visual conditions (13.2%), and both support and visual conditions (8.4%). Limited task role variability was sccn within measures, with 73.1% of measures examining only one task role. Environmental variation was present in 65.3% of measures, primarily during static body stability tasks. Few measures involved object interaction (23.1%), obstacle negotiation (38.5%), external forces (11.5%), dual-tasking (7.7%), or moving people or objects (0%). Limitations. The classification framework was not externally validated. Conclusions. Existing measures focus on single-task assessment in static environments, underrepresenting postural control demands in daily-life situations involving dynamic changing environments, person-environment interactions, and multitasking. New items better reflecting postural control demands in daily-life situations are needed for more ecologically valid balance assessment. Individual balance measure profiles provided can help identify the most appropriate measure for a given purpose., Balance, or postural control, t depends on interaction of multiple body systems, with postural control demands being influenced by the complexity of the task and the environment in which the [...]

Evidence-based practice (EBP) is firmly entrenched in the lexicon of physical therapist practice, (1,2) but beliefs about how best to translate scientific evidence into clinical practice are far from settled. [...]

America is about to experience a demographic shift of enormous magnitude: increasing longevity, declining fertility, and the aging of the baby boomers, which are triggering an enormous 'age wave.' We are facing the challenge of limited access to health care services by millions of our citizens, and unsustainable cost escalation. In response, health care is changing fundamentally. In the 2012 McMillan Lecture, Jette discusses 3 critical 'system skills' that physical therapists must develop to practice successfully in a changing health care environment. First, therapists must become interested in data. Second, they must become skilled in the ability to devise solutions for the system problems that data and experience uncover. Third, the physical therapy profession must develop the ability to implement at scale--the ability to get therapists along the entire chain of care functioning in concert, in collaboration. Jette discusses the American Physical Therapy Association's Vision 2020 as it relates to these challenges and the degree to which he believes physical therapists are equipped with the system skills needed to function within effective health care systems to identify what works in physical therapy, for what conditions, under what circumstances, and at what cost. Jette articulates a revised vision for physical therapy that includes being a leader in teaching systems skills to practice successfully in interconnected heath care teams; being a recognized national leader in implementing evidence-based strategies; using standardized collection, analysis, and dissemination of intervention and outcomes data as a regular part of practice to determine what interventions best improve the health of individuals and society; and being a profession that is a central player in devising, evaluating, and implementing cost-effective health care innovations for communities as well as for individuals., As with so many former McMillan awardees, I read through the previous McMillan Lectures as part of my preparation (Fig. 1). They represent illuminating insights into our profession across the [...]

Background. Impaired balance has a significant negative impact on mobility, functional independence, and fall risk in older adults. Although several, well-respected balance measures are currently in use, there is limited evidence regarding the most appropriate measure to assess change in community-dwelling older adults. Objective. The aim of this study was to compare floor and ceiling effects, sensitivity to change, and responsiveness across the following balance measures in community-dwelling elderly people with functional limitations: Berg Balance Scale (BBS), Performance-Oriented Mobility Assessment total scale (POMA-T), POMA balance subscale (POMA-B), and Dynamic Gait Index (DGI). Design. Retrospective data from a 16-week exercise trial were used. Secondary analyses were conducted on the total sample and by subgroups of baseline functional limitation or baseline balance scores. Methods. Participants were 111 community-dwelling older adults 65 years of age or older, with functional limitations. Sensitivity to change was assessed using effect size, standardized response mean, and paired t tests. Responsiveness was assessed using minimally important difference (MID) estimates. Results. No floor effects were noted. Ceiling effects were observed on all measures, including in people with moderate to severe functional limitations. The POMA-T, POMA-B, and DGI showed significantly larger ceiling effects compared with the BBS. All measures had low sensitivity to change in total sample analyses. Subgroup analyses revealed significantly better sensitivity to change in people with lower compared with higher baseline balance scores. Although both the total sample and lower baseline balance subgroups showed statistically significant improvement from baseline to 16 weeks on all measures, only the lower balance subgroup showed change scores that consistently exceeded corresponding MID estimates. Limitations. This study was limited to comparing 4 measures of balance, and anchor-based methods for assessing MID could not be reported. Conclusions. Important limitations, including ceiling effects and relatively low sensitivity to change and responsiveness, were noted across all balance measures, highlighting their limited utility across the full spectrum of the community-dwelling elderly population. New, more challenging measures are needed for better discrimination of balance ability in community-dwelling elderly people at higher functional levels., Balance, an integral component of physical function, is a fundamental area of assessment and intervention in adult rehabilitation. (1) Critical for normal performance of basic and advanced activities of daily [...]

Background. Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function. Although conceived as representing similar concepts, differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically. Objective. The purpose of this study was to compare the Short Physical Performance Battery (SPPB) with the function component of the Late-Life Function and Disability Instrument (LLFDI) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care. Design. This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults (N=137) with mobility limitations enrolled in a randomized controlled trial of exercise. Methods. A performance-based measure of function (the SPPB) and a self-report measure of function (the LLFDI) served as functional outcomes. Physiologic factors included measures of leg strength, leg velocity, and exercise tolerance test (ETT) duration, which served as a surrogate measure of aerobic capacity. Psychosocial and health factors included age, sex, height, body mass index, number of chronic conditions, depression, and falls efficacy. Results. Separate multivariable regression models predicting SPPB and LLFDI scores described 33% and 42% of the variance in each outcome ([R.sup.2]), respectively. Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures. Leg strength and age were positively associated with SPPB scores, whereas number of chronic conditions, sex, and falls efficacy were associated with the LLFDI scores. Limitations. This study included older adults with mobility limitations and may not generalize to other populations. Conclusions. Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person's functioning. The SPPB was associated with age and physiologic factors, whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors., Functional limitations measured through standardized observation of physical performance or patient-reported function have been recognized as important rehabilitation outcomes as well as a potentially important means of identifying individuals at [...]

In this issue of PTJ, Magnusson and colleagues (1) offer a timely discussion of population health. As a physical therapist with graduate degrees in public health and who spent much [...]

PTJ's Editorial Board has occasionally been asked to defend why the journal publishes qualitative research. As editors, we are tasked with deciding what types of articles to prioritize for publication. [...]

In early December 2018, I was privileged to attend a 2-day workshop titled 'The Role of Nonpharmacological Approaches to Pain Management' sponsored by the National Academy of Sciences, Engineering, and [...]

In this issue of PTJ, Ellis and colleagues (1) provide promising preliminary evidence of the effectiveness, safety, and acceptability of a behavioral change, mobile health (mHealth)--mediated exercise program designed to [...]

Even though PTJ has required prospective clinical trial registration since January 2009, I am becoming increasingly aware that the application of our clinical trial registration policy does confuse some authors. [...]

The idiom 'canary in a coal mine' originated in the 19th century. Canaries are especially sensitive to methane and carbon monoxide, 2 gases common in coal mines. The miners kept [...]

In the March 2018 issue of PTJ, I wrote about a recent National Academies of Sciences, Engineering, and Medicine (NASEM) consensus study that characterized the opioid epidemic and recommended actions [...]

Albert Einstein wrote that 'all religions, arts, and sciences are branches from the same tree.' (1) He made this statement in a letter to the YMCA, in October 1937, against [...]

Background and Purpose. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) is gaining recognition in physical therapy. The Extended ICF Core Set for Stroke is a practical tool that represents a selection of categories from the whole classification and can be used along with the ICF qualifier scale to describe patients' functioning and disability following stroke. The application of the ICF qualifier scale poses the question of interrater reliability. The primary objective of this investigation was to study the agreement between physical therapists' ratings of subjects' functioning and disability with the Extended ICF Core Set for Stroke and with the ICF qualifier scale. Further objectives were to explore the relationships between agreement and rater confidence and between agreement and physical therapists' areas of core competence. Subjects and Methods. A monocentric, cross-sectional reliability study was conducted. A consecutive sample of 30 subjects after stroke participated. Two physical therapists rated the subjects' functioning in 166 ICF categories. Results. The interrater agreement of the 2 physical therapists was moderate across all judgments (observed agreement=51%, kappa=.41). Interrater reliability was not related to rater confidence or to the physical therapists' areas of core competence. Discussion and Conclusion. The present study suggests potential improvements to enhance the implementation of the ICF and the Extended ICF Core Set for Stroke in practice. The results hint at the importance of the operationalization of the ICF categories and the standardization of the rating process, which might be useful in controlling for rater effects and increasing reliability., The World Health Organization's (WHO's) International Classification of Functioning, Disability and Health (ICF) (1) is gaining recognition in physical therapy and rehabilitation. (2-5) The ICF provides a conceptual basis and [...]

Background and Purpose The purpose of this study was to prospectively evaluate the practical and psychometric adequacy of the Activity Measure for Post-Acute Care (AM-PAC) "item bank" and computerized adaptive testing (CAT) assessment platform (AM-PAC-CAT) when applied within orthopedic outpatient physical therapy settings. Method This was a prospective study with a convenience sample of 1,815 patients with spine, lower-extremity, or upper-extremity impairments who received outpatient physical therapy in 1 of 20 outpatient clinics across 5 states. The authors conducted an evaluation of the number of items used and amount of time needed to complete the CAT assessment; evaluation of breadth of content coverage, item exposure rate, and test precision; as well as an assessment of the validity and sensitivity to change of the score estimates. Results Overall, the AM-PAC-CAT's Basic Mobility scale demonstrated excellent psychometric properties while the Daily Activity scale demonstrated less adequate psychometric properties when applied in this outpatient sample. The mean length of time to complete the Basic Mobility scale was 1.9 minutes, using, on average, 6.6 items per CAT session, and the mean length of time to complete the Daily Activity scale was 1.01 minutes, using on average, 6.8 items. Background and Conclusion Overall, the findings are encouraging, yet they do reveal several areas where the AM-PAC-CAT scales can be improved to best suit the needs of patients who are receiving outpatient orthopedic physical therapy of the type included in this study., Computerized adaptive testing (CAT), an outcome measurement approach for comprehensive and precise assessment of patient-related outcomes, is being used with increasing frequency in the health care field. (1-3) This method [...]

Within physical therapy, the disablement model has proven useful as a language to delineate the consequences of disease and injury. This perspective provides an update on the changing language of disablement, reviews selected contemporary disablement models, and discusses some challenges that need to be addressed to achieve a universal disablement language that can be used to discuss physical therapy research and clinical interventions. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework has the potential of becoming a standard for disablement language that looks beyond mortality and disease to focus on how people live with their conditions. If widely adopted, the ICF framework could provide the rehabilitation field with a common, international language with the potential to facilitate communication and scholarly discourse across disciplines and national boundaries, to stimulate interdisciplinary research, to improve clinical care, and ultimately to better inform health policy and management. Key Words: Health status, Measurement: applied, Outcome assessment (health care), Physical disability, Professional issues., The ability to communicate with one another and to speak and be understood across related professional disciplines is fundamental to the science and the practice of physical therapy. Within physical [...]

The general objective of the Rehabilitation Medicine Summit: Building Research Capacity was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were: (1) researchers, (2) research environment, infrastructure, and culture, (3) funding, (4) partnerships, and (5) metrics. The [approximately] 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small-group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report. [Frontera WR, Fuhrer MJ, Jette AM, et al. Rehabilitation Medicine Summit: Building Research Capacity-Executive Summary. Phys Ther. 2006;86:285-298.], The advancement of medical science depends on the production, availability, and utilization of new information generated by research. A successful research enterprise depends not only on a carefully designed agenda [...]

In 2019, we celebrate not only the 50th anniversary of the Apollo 11 moon landing, but the graduation of the first cohort of physical therapist assistants (PTAs) from the College [...]

I thank Dr Olaoye Akinyemi for his thoughtful letter to the editor that is being published in this issue of PTJ. (1) For me, his letter highlighted an important point [...]

In the current issue of PTJ, we are publishing 2 timely and important systematic reviews that illustrate the utility of the World Health Organization's (WHO) International Classification of Functioning, Disability [...]

In February, I had the distinct pleasure of attending the 2018 International Sepsis Forum's Colloquium on Under-standing and Enhancing Sepsis Survivorship. I was asked to share some lessons learned from [...]

Peer review--the process by which experts advise journal editors on the scientific quality, originality, and potential impact and relevance of scientific manuscripts submitted for publication--is relied upon by editors as [...]

As we know, rates of opioid use disorder (OUD) and opioid overdose deaths in the United States have reached unprecedented and frightening levels over the past 2 decades. The US [...]

In Richard K. Shields's McMillan Lecture, (1) he exhorted physical therapists to take full advantage of the opportunities presented by the National Institutes of Health (NIH) All of Us cohort [...]

In its National Quality Strategy, the US Department of Health & Human Services' Centers for Medicare and Medicaid (CMS) has broadly defined its interest in valued-based purchasing (VBP) to achieve [...]

In July, I returned home from the World Confederation for Physical Therapy (WCPT) Congress in Cape Town, South Africa, encouraged by the quality of rehabilitation science I heard presented there. [...]

Those of us fortunate enough to have attended the American Physical Therapy Association (APTA) 2017 NEXT Conference & Exposition in Boston in June were treated to an inspiring Mary McMillan [...]

Background and Purpose. The primary goal of this investigation was to describe outpatient physical therapy treatments provided to patients with lumbar, cervical, or knee impairments. Subjects. Patients in this analysis received outpatient physical therapy for a primary orthopedic complaint during July 1993 through June 1994 from one of 68 practices participating in the Focus on Therapeutic Outcomes database. Data were available on 2,598 completed physical therapy episodes of care provided by 141 therapists. Methods. At each patient's discharge, the primary physical therapist gave information on the treatments provided to each patient during the initial, middle, and final thirds of the episode of therapy as well as information on primary source of reimbursement. Patients provided information on the date of onset of their symptoms or surgery. Results. These outpatient physical therapy episodes of care were characterized by a diverse array of modalities, exercises, and manual therapy treatments. Treatment choices varied by type of impairment and across thirds of the episode. Fee-for-service versus managed care payment arrangements were associated with increased use of devices, therapeutic massage, strengthening, and endurance exercises. Conclusion and Discussion. The study's findings revealed that although physical agents were frequently used in physical therapy episodes of care, they were applied along with exercise and manual therapy interventions. Future research should relate specific treatments to variation in patient outcomes following physical therapy., [Jette AM, Delitto A. Physical therapy treatment choices for musculoskeletal impairments. Phys Ther. 1997;77: 145-154.] Key Words: Health services research, Low back pain, Musculoskeletal system, Orthopedics, Outcomes. In the United [...]

Background and Purpose. Physical therapy is usually initiated with the belief that treatment will improve patients' health, particularly the ability to perform daily activities and function in expected roles. The purpose of this report to describe health outcomes and related factors in patients with knee impairments receiving physical therapy. Subjects. Data were obtained from a sample of 426 patients with knee impairments treated in 63 physical therapy practices across the United States. Methods. Data were obtained during 1993 and 1994 from the Focus on Therapeutic Outcomes database. Health outcomes over an episode of physical therapy care were described using the SF-36 and the Lysholm Knee Rating Scale. Multivariate analyses were used to determine which patient and treatment characteristics were associated with these outcomes. Results. The patients, health improved, as measured by all but one of the SF-36 outcomes scales, with effect sizes ranging from 0.18 to 0.93 in scales in which change occurred. The patient and treatment characteristics that were studied accounted for 23% to 37% of the variability in health outcomes. Conclusion and Discussion. Patients who were older, had no surgery, were out of work because of their health, or were depressed were more at risk for poor health outcomes than were patients without these characteristics. These findings suggest a need for physical therapists to look for new approaches to identifying and treating patients with these characteristics. [Jette DU, Jette AM. Physical therapy and health outcomes in patients with knee impairments. Phys Ther. 1996; 76; 1178-1187.], Key Words: Knee injuries; Lower Extremity, knee; Outcome and process assessment (health care). Musculoskeletal impairments account for a large percentage of conditions for which medical care is sought in the [...]