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Introduction Overview of the Issue The maternal mortality ratio is defined by the World Health Organization as the death of a woman while pregnant or within 42 days of pregnancy [...], Patients with a high-risk pregnancy or who immediately give birth are often not provided access to acute care occupational and physical therapy during their hospital admission. The greatest potential for health care crises, including maternal mortality, occurs during the first 6 weeks after birth. Maternal mortality and morbidity, which continue to rise in the United States, are considered indicators of the overall population health of a country. It is estimated that over 80% of pregnancy-related deaths are preventable. The leading causes of death within the first 6 weeks after birth are hemorrhage, hypertensive disorders, and infection. Implicit biases about childbearing individuals who are perceived to be relatively young, independent, active, and healthy may unintentionally contribute to areas of substandard care that adversely impact maternal health outcomes. It is a professional and ethical imperative that health providers, including occupational and physical therapists, establish themselves as allies to patient groups at high risk for disparate treatment. The Acute Care OB Rehab Implicit Bias Self-Reflection Tool is an instrument designed for health providers to identify stereotypes that may contribute to inequitable access to rehabilitation in the hospital after birth. Including rehabilitation services for the perinatal population in the hospital setting can play a pivotal role in early detection of adverse events with activity that may directly impact the increasing maternal mortality rate in the United States. Keywords: Disparities, Maternal Health, Obstetrics Rehabilitation

Disparities in Rehabilitation Access: The Imperative for Change Globally, the enormous need for rehabilitative services is well-documented, with a recent study in the Lancet reporting that 1 in 3 patients [...], As the field evolves as a doctoring profession, the role and scope of physical therapist practice must also grow to meet important and urgent public health needs. Scalable, population-level interventions must be prioritized to the same degree as tailored, individual-level care. Drawing from public health frameworks, this perspective proposes an approach to population-level physical therapist care delivery that aims to mitigate disease and disability and improve health outcomes by expanding access, decreasing cost, and improving quality of care for those facing the greatest health disparities. Application of these frameworks prompts the development of novel approaches to rehabilitation service delivery to advance twin goals of promoting access to care and reducing health disparities. This paper describes how a population health framework and public health approach can be used to support necessary evolution and innovation within the field of physical therapy and to improve rehabilitation service delivery. Rapid developments in the digital and virtual health space have created a unique opportunity for physical therapists to lean into a new vision of their role as clinicians within the broader health ecosystem. This paper will provide clinicians with a broader perspective of physical therapist expertise and describe opportunities for the development and application of a physical therapist skill set toward driving population health outcomes. Real-world examples will guide clinicians to consider opportunities in their own practice for implementing this public health approach and potentially addressing various contributors to persistent health disparities. Keywords: Public Health, Health Services Accessibility, Rehabilitation, Technology

Introduction Chronic musculoskeletal pain conditions are among the greatest contributors to years lived with disability worldwide, and their impact has steadily increased since 1990. (1,2) Partaking in leisure time and [...], Objective. Self-efficacy for leisure-time or health-promoting physical activity (SEPA) is a psychosocial determinant of physical activity. The socioecological model can provide a robust perspective of SEPA. The objective of this study was to synthesize the evidence on multilevel correlates of SEPA among individuals with chronic musculoskeletal pain. The second aim examined the extentto which socioecological disparities are associated with SEPA among individuals with chronic musculoskeletal pain. Methods. An integrative review was conducted. Included studies needed to investigate the relationship between SEPA and socioecological factors at the interpersonal, institutional, community, and/or macrosystem level among adults with chronic musculoskeletal pain ([greater than or equal to]3 months). Searches in PubMed, EMBASE, PsycINFO, and CINAHL were performed (December 30, 2020, and October 12, 2022), yielding 4047 records after duplicates were removed. Two independent reviewers completed screening, full-text reviews, and data extraction. After title and abstract screening and full-text reviews, 17 studies were included. The constant comparison method included: data reduction, data display, data comparison, and conclusion drawing/verification. Quality of evidence was assessed using the Joanna Briggs Institute appraisal tools. Results. Five themes emerged with respect to relationships between SEPA and socioecological factors: social relations, social comparisons, patient-provider relationship, organizational resources, and accessibility to physical activity. Relationships between interpersonal factors and SEPA were most prominently studied. One study examined and addressed potential disparities in SEPA at the macrosystem level. Conclusion. A spectrum of relationships from supporting to straining SEPA were found at the interpersonal level. Relationships between institutional, community, and macrosystem factors and SEPA were comparably sparse. Gaps in the literature were identified regarding how health disparities present across the socioecological model with respect to SEPA. Impact. Clinicians can use this review to evaluate how SEPA can be supported or threatened by factors across the socioecological model. This may be a preliminary step towards examining and addressing health disparities in SEPA. Keywords: Musculoskeletal Pain, Physical Activity, Self-Efficacy, Socioecological

Introduction The pervasive inequities in health care experienced by historically marginalized groups are well documented. (2) The SARS-CoV-2 pandemic and recent social injustices have magnified the systemic racism and discrimination [...], The COVID-19 pandemic and recent incidents of social injustice exposed the systemic racism and discrimination in health care and clinical research that perpetuate systemic inequities. This perspective utilizes the acronym JEDI (justice, equity, diversity, and inclusion) as a vision for addressing inequities in physical therapy research. The need to go beyond diversity and focus on inclusion, equity, and justice is emphasized to achieve transformation within physical therapy research. The prevailing research paradigms are examined, acknowledging that research can perpetuate inequities and reinforcing the importance of integrating JEDI principles into the research process. The underrepresentation of diverse researchers in physical therapy is discussed, as well as the barriers faced by underrepresented researchers and research participants. Funding disparities are also highlighted, emphasizing the need for JEDI principles in research funding practices. How other health professions' associations are addressing JEDI in research is also explored. The authors propose a framework for action, utilizing the concepts of the socioecological model to identify gaps in JEDI within physical therapy research at different levels of influence and conclude by emphasizing the importance of justice in dismantling inequitable systems and urge the physical therapy research community to become JEDI warriors to bring about transformative change. Impact. By championing cultures that value justice, equity, diversity, and inclusion, individuals within the physical therapy research community have the potential to ignite a powerful transformation in society. The authors envision a future where JEDI warriors emerge, embracing the spirit of "Do or do not. There is no try," to forge a research community that is inclusive for all. (1) Drawing inspiration from this mindset, this perspective seeks to empower individuals to harness the force of a JEDI warrior, fostering cultures that value justice, embrace inclusive methodologies, and ensure equitable access to resources and opportunities for researchers and participants. Keywords: Emancipatory Research, Funding Disparities, Qualitative Methods, Socioecological Framework

Introduction Inequity in physical therapy takes many forms, from disparities in health care access, quality, and outcomes to unequal access to professional education programs to limited diversity of program directors, [...], Objective. Discussions of the root causes of health disparities and educational inequities often neglect to identify racism as a primary factor. Researchers must take a systems perspective to identify the effects of racism and other forms of systemic oppression on health. It is unclear to what extent this perspective exists in the physical therapy research literature. We conducted a scoping review to quantify and describe the volume of research in physical therapy pertaining to diversity, equity, and inclusion specifically examining race and/or ethnicity and references racism or antiracism. Methods. A systematic search of PubMed and Scopus databases for articles published between 1997 and 2021 was conducted. Articles were screened to ensure they were focused exclusively or primarily on physical therapy and used diversity, equity, and inclusion terms in the context of personal identity factors. This resulted in 158 relevant articles. Each was tagged with an article type and personal identity factor focus. Results. A majority of the included articles were descriptive/observational in nature. The included articles explored various personal identity factors, with race and ethnicity being the most common focus followed by culture, disability, and socioeconomic status. A small proportion of articles explicitly discussed racism or antiracism. Conclusion. These findings highlight the need in physical therapy research for greater attention to racism as a fundamental cause of health disparities and educational inequities. Addressing this gap is crucial for promoting diversity, equity, and inclusion within the field and ultimately achieving optimal health outcomes for marginalized populations. Impact. Including consideration of racism and otherforms of systemic oppression in the motivation, design, and interpretation of research in physical therapy will help to make more visible the root causes of inequity and improve our ability to develop effective, multi-level interventions. Keywords: Culture, Ethnic Groups, Health Services Accessibility, Peer Review: Research, Physical Therapists, Professional Issues, Public Health, Social Responsibility, Socioeconomic Factors

Introduction One in 4 Americans have a disability. (1) Of people with disabilities who are employed, only 8% work in health care, (2) yet in a 2022 survey from an [...], People with disabilities are considered a historically marginalized population that experiences significant health disparities resulting from the unequal distribution of resources as evidenced in the social determinants of health. Health professions education presents an opportunity to explore the policy, systems, and environmental changes that are needed to improve social conditions and address known disparities for people with disabilities. Evidence suggests that inclusion of learners with diverse lived experiences, including students with disabilities, strengthens our understanding of the influence of social determinants on health and our ability to address known barriers. Unfortunately, people with disabilities and other minoritized individuals are grossly underrepresented in physical therapy. It is imperative that doctor of physical therapy (DPT) education more intentionally promotes the full inclusion of students with disabilities to improve representation and to better support the complex needs of this population. In this perspective, we describe key social determinants of health for people with disabilities, offer strategies for increasing representation and inclusion of students with disabilities in DPT education, and summarize how the inclusion of students with disabilities in DPT education can enhance our understanding of and ability to address social barriers for this population. Keywords: Disability, Physical Therapy Education, Social Determinants of Health, Social Responsibility, Students With Disabilities

Introduction 'Gulf-sized race-based gaps exist with respect to the health, wealth, and well-being of American citizens. They were created in the distant past, but have indisputably been passed down to [...], Patient history assists clinicians in determining the most appropriate tests to identify the symptoms' source and select appropriate interventions. Therefore, a subjective history is an essential component of patient management. When physical therapist practitioners transition into academia, they must understand how the history of the education system may affect learners. Health disparities are related to the lack of workforce diversity and skills in cultural responsiveness, and the education system is critical in addressing the impact of future providers on health disparities. Developing a doctor of physical therapy program to address health disparities requires an analysis of the historical context of the US educational and health care systems, along with traditional components of physical therapist education. This country's education system was built upon a 2-tiered system, where minoritized individuals struggled to overcome barriers imposed by legislation and societal beliefs. Jim Crow laws continued this unequal access to education, and the recent Supreme Court ruling to deny race-based affirmative action continues these inequities. This historical context informed the construction of the College of Saint Mary Doctor of Physical Therapy Program. The program's mission led to using less traditional educational approaches; thus, the pillars of practice took form. The 5 pillars evolved to include social determinants, inclusive faculty and student recruitment and retention practices, equitable grading, culturally responsive pedagogy, and community development. The purpose of this paper is to present a historical overview of the US education system and its influence on physical therapist education. Furthermore, it will illustrate how this historical context inspired the 5 Pillars of Community Practice from College of Saint Mary and discuss the challenges and interventions related to these pillars. There are tremendous disparities in educational outcomes and patient services in the United States. Disparities are most significant in those with historically marginalized identities. If those disparities are to improve, a change is required in the people providing care to patients. The best way to accomplish this is by transforming how future providers are educated. Keywords: Education: Faculty, Health Disparities, History of Education, Supreme Court

Introduction The United States trails behind other high-income countries on many health care outcomes. Specifically, the United States ranks last among high-income countries when it comes to affordability and access [...], The purpose of this perspective is to discuss the imperative for curricular change that focuses on the utilization of structural competency to promote excellence in physical therapist professional education, transform society, and achieve health equity. Pedagogy centered around biomedical and social determinants of health (SDOH) models are limited in that they lack self-reflexivity, encode social identities like race and gender as risk factors for poor health, fail to examine structural causes of health inequity, conflate SDOH and the structural forces that shape their unequal distribution, and overlook instances of injustice. Promoting health equity will require structural competency, an approach that considers drivers of health beyond the individual and their conditions of daily living (ie, SDOH). Utilizing this approach in physical therapist professional education will help learners understand the evolving needs of society in a deeper, more holistic way: one that considers structural determinants of health as the primary drivers of health equity and inequity. Impact. This paper provides a perspective on how physical therapist professional education can promote health equity for all by embracing an equity-focused, structurally competent pedagogy/approach. Keywords: Health Equity, Political Determinants of Health, Structural Competency, Social Determinants of Health, Structural Determinants of Health

Introduction 'Real education means to inspire people to live more abundantly, to learn to begin with life as they find it and make it better...' --Carter G. Woodson In 1933, [...], Physical therapists should be able to screen patients for social determinants that impact health and refer to community resources as appropriate. To make appropriate referrals, physical therapists must equip themselves with skills to connect patients and clients to community resources outside the walls of their respective institutions, starting with developing these practices in physical therapist education programs. Experienced community builders recommend a community development approach where residents initiate and agree upon decisions, and outside stakeholders work as partners to elevate the community. The community should be supported to determine the desired outcomes in ways that enhance equity, inclusion, and social justice. Communities play a substantial role in health outcomes. Studies indicate that 85% of one's health is connected to community and economic resources, while only 15% is affected by medical interventions. Connected communities are potent tools to enhance health. Connected communities are places where residents nurture neighborhood relationships that enable them to work together to create a good life supporting their collective well-being. The community-builder approach recenters people and their communities as fundamental health leaders; institutions can use their resources to elevate communities by relocating authority back to communities. Communities have assets and resources largely unrecognized, disconnected, and not mobilized by residents. Institutions are positioned to support citizens and their associations in discovering, connecting, and mobilizing these assets. This asset-based community development approach focuses on 5 principles: place-based, citizen-led, relationship-oriented, asset-based, and inclusion-focused. This perspective paper will describe ways institutions can elevate communities; the benefits of community development practices in physical therapist education programs; and explore examples of community partnerships and best practices to develop equitable alliances with residents in the community. Impact. A large part of one's health is directly related to where one lives. Physical therapists and physical therapist assistants can play a vital role in improving the health of society by engaging in their local communities through community development. Community development is a practice where community members and outside stakeholders, such as physical therapists, come together to meet the needs of a community. Keywords: Community Development, Community Engagement, Outreach

Introduction The lack of representation of the general population in physical therapy education and practice has been unresolved for decades. (1,2) Issues reported by the Institute of Medicine (2) concerning [...], The push for holistic admissions practices in physical therapy education has evoked concerns that learners who are culturally and linguistically diverse might be less qualified than the predominant demographic traditionally admitted into programs. The implications are that culturally and linguistically diverse learners struggle academically and experience challenges passing the National Physical Therapy Examination. However, as the academic preparedness of learners is discussed, rarely does the conversation include the capabilities of faculty to teach these learners. As cohorts continue to include learners from a greater variety of backgrounds and identities, the largely homogenous professorate, with more than 80% identifying as White, might need training in culturally responsive pedagogy to best serve learners from all backgrounds and identities. Educators often use a "one-size-fits-all" approach in which learners are expected to use the same resources and pace for assignments, readings, and assessments, regardless of their learning strengths or academic preparation. That approach fails to empower educators to design curricula and instruction to position all learners to excel in the classroom. This Perspective explores strategies to support all learners through three dimensions of culturally responsive pedagogy: institutional, personal, and instructional. To truly transform society, we must first transform physical therapy education. Culturally responsive pedagogy advances and supports all student achievement by recognizing, fostering, and using their strengths in the learning environment. Keywords: Culturally Awareness, DEI, Diversity, Pedagogy, Teaching

Introduction: Disability, Health Disparities, and Lack of Disability Competence Disability is a ubiquitous human experience. About 1 in 4 Americans report having a disability, belonging to what is the largest [...], Americans with disabilities represent the largest historically underserved and marginalized health disparity population in the United States. This perspective piece will raise the awareness of physical therapist faculty and clinicians on gaps in health care provider knowledge about disability and provide actionable strategies, frameworks, and resources available to improve disability competence to make changes in clinical education and practice. In this perspective piece, 3 contributions are made. First, health disparities experienced by Americans with disabilities as a result of health care providers' biased assumptions about disability and lack of disability competence are described through an in-depth illustration of lived experiences of people with disabilities. Second, a discussion of disability competence in physical therapist education is provided. Finally, critical and evidence-based insights and actionable frameworks and resources to address disability competence training gaps and to promote anti-ableist practice are provided. Keywords: Disability, Education: Competency-Based, Health Disparities

Introduction Physical therapists are increasingly called to examine how social determinants of health (SDOH) influence physical therapist practice, advocacy, research, and education. (1-3) As an organizing paradigm, an SDOH framework [...], Objective. The aim of this study was to explore the instruction of social determinants of health (SDOH) for people with disabilities (PWD) in doctor of physical therapy (DPT) education programs. Methods. A sequential mixed methods study informed by a five-member disability community advisory panel was conducted. Qualitative semi-structured interviews with educators (n = 10) across 4 DPT programs in the Midwest were conducted and analyzed thematically. The qualitative findings formed the basis of the quantitative phase. An online survey was conducted with faculty of DPT programs in the United States (n = 254) with the most knowledge of instruction of SDOH and health equity for PWD (n = 74; 29% response rate). Quantitative data were analyzed with descriptive statistics and triangulated with qualitative data. Results. SDOH for PWD is an emerging component of instruction in DPT curricula. Five themes included: emerging instruction of SDOH for PWD; conceptual frameworks informing instruction; instructional strategies; barriers to integration of SDOH for PWD; and facilitators to integration of SDOH for PWD. Quantitative analysis revealed that 71 respondents (95.9%) included disability in health equity discussions primarily focused on health care access. Limited time (n = 49; 66.2%) was the most frequently reported barrier, and educator interest in disability health equity was the most frequently reported facilitator (n = 62; 83.7%) to inclusion of the SDOH for PWD in health equity discussions. Conclusion. Opportunities exist in DPT curricula to build on instructional strategies, integrate SDOH frameworks, and amplify facilitators to integration of SDOH for PWD. Impact. To meet the needs of the 67 million Americans living with disabilities, students must have the knowledge and skills to address the complex needs of this historically marginalized population. Understanding the DPT education landscape around SDOH for PWD can guide DPT educators to more fully prepare their students to recognize and ameliorate health disparities faced by PWD. Keywords: Disability, Disabled Persons, Education: Physical Therapist Students, Social Responsibility

Introduction Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. (1) Approximately 20 million [...]

Introduction In this article, we aim to inform readers about the prevalence and impact of sexual dysfunction (difficulty or impairment in undertaking sexual activity or in experiencing sexual pleasure and [...], People living with chronic primary or secondary musculoskeletal pain conditions such as low back pain, fibromyalgia, and inflammatory arthritis typically experience wide-ranging impacts on their physical function, activity participation, and psychosocial wellbeing. These can extend to negative impacts on a person's sexual function and their intimate relationships. While sexual function is an important component of wellbeing, it is often not considered within musculoskeletal pain care. Without awareness or targeted training, physical therapists may lack the confidence and skills to screen, assess, and manage the impacts that pain may be having on a person's sexual function and can miss the opportunity to tailor their care and optimize wellbeing. This article seeks to raise awareness among physical therapists of how living with chronic musculoskeletal pain can impact a person's sexual function and intimate relationships, and provide guidance on how to consider these issues within a person-centered approach to care. It describes why considering sexual function and intimate relationship issues as part of a person's lived musculoskeletal pain experience may be relevant, outlines the use of validated patient-reported outcome measures to assess sexual dysfunction, and suggests practical strategies for sensitively raising sexual function in consultations. Management approaches and possible referral pathways are also presented, to assist physical therapists in understanding available care options. This article seeks to support holistic care by improving physical therapists' knowledge and understanding of sexual dysfunction and its management in people living with chronic musculoskeletal pain. Impact. Considering sexual function as a valued functional activity, together with other activities of daily living, will assist physical therapists to provide more holistic and person-centered care. This article covers the main considerations for raising sexual function and intimate relationship issues with people living with chronic musculoskeletal pain, as well as management options and potential referral pathways. Physical therapists are encouraged to seek targeted training to improve their confidence and skills in this area, and to use inclusive, respectful language for discussions around sexual function and intimate relationships. Keywords: Clinical Assessment, Intimate Relationships, Musculoskeletal Pain, Physical Therapy, Referral Pathways, Sexual Function

The physical therapist profession is increasingly aware that lesbian, gay, bisexual, transgender, queer, intersex, and/or asexual (LGBTQIA+) persons have unique healthcare needs. (1) Recognizing this need, the American Physical Therapy [...], Keywords: Equity, Inclusivity, LGBTQIA+ Affirmative Care, LGBTQIA+ Health Disparities, LGBTQIA+ Inclusive Care, LGBTQIA+ Practice Guidelines, LGBTQIA+, LGBTQIA+ Health, LGBTQIA+ Guidelines, Trauma-Informed Care

Introduction Arthroplasty is a crucial intervention for curing severe joint diseases and injuries by restoring joint function and reducing pain, significantly enhancing patients' physical health and quality of life. (1,2) [...], Objective. The objective of this study was to conduct a systematic and comprehensive review of qualitative research to examine the physical and psychological needs, as well as work experiences, of patients undergoing total knee replacement and total hip replacement surgeries during their process of returning to work. Methods. A systematic review and meta-synthesis of qualitative literature was conducted. A systematic search was conducted across 8 databases to identify qualitative or mixed-methods research on the needs and experiences of individuals with total knee replacement and total hip replacement who have returned to work. The search period extended from the inception of each database to March 2023. Two researchers independently utilized a predetermined search strategy to retrieve relevant English-language studies published in any year. The included studies were assessed for quality using the Critical Appraisal Skills Program appraisal tool. Findings from the studies were then summarized and integrated using the pooled integration method. Results. There were 10 studies in total. Three key themes were identified from the original research: needs during the return to work process and rehabilitation training, faith and support to return to work, and constraints and challenges at work. Conclusion. Health care professionals and employers should conscientiously consider the physical and psychological requirements of patients who have undergone total knee replacement and total hip replacement when they are resuming work, taking into account the specific constraints and challenges that may arise in the workplace. To ensure a seamless transition back to work, it is essential to develop tailored occupational interventions, implement comprehensive return to work programs, and offer patients sufficient understanding and support. Impact. The findings of this study offer valuable insights into the physical and psychological needs, as well as the work experiences, of patients who have undergone total knee replacement and total hip replacement during their reintegration into the workforce. These findings have the potential to assist health care professionals and employers in providing enhanced support to facilitate successful return-to-work outcomes for patients. Keywords: Meta-Synthesis, Qualitative Research, Return to Work, Systematic Review, Total Hip Arthroplasty, Total Knee Arthroplasty

Introduction Patients affected by progressive neurological disease in the later stages are prone to pulmonary complications, (1) characterized by impaired ventilation and cough, which can increase morbidity and mortality. (2) [...], Objective. The goal of this study was to explore the patient-physical therapist interaction and the physical therapist's experience of the introductory session for mechanical insufflation-exsufflation (Ml-E) device treatment for patients with progressive neurological disease. Methods. Qualitative content analysis of participant's observation of interaction between patients and physical therapists during 9 Ml-E introduction sessions in different clinical care settings and 10 follow-up interviews with 6 physical therapists. Results. The introduction of Ml-E emerged as a process of instilling a sense of security in the patient. The process can be described in 4 steps: (1) gain understanding by being responsive to the person's whole life situation; (2) share knowledge and expectations in a respectful and permissive way; (3) introduce the device in a gentle and reciprocal interactivity; and (4) adapt to home use in an inclusive dialog with the patient and their significant others. Physical therapists described a need for assurance to instill a sense of security in the patient, implying a need for confidence, competent peers, guiding yet flexible routines, and emotional support. Conclusion. Physical therapists have a need to foster assurance in employing a person-centered approach to make a patient feel secure in the process of introducing Ml-E treatment. Multiple modes of professional knowledge were used together with action-based and relational-based ethics to facilitate a person-centered care approach. This seems to be a promising approach for providing good care when introducing Ml-E to patients. Further research is needed to explore this from the patient's perspective. Impact. This study added to the body of knowledge regarding Ml-E treatment in relation to patients. This has direct implication, particularly for inexperienced physical therapists, for informed care for the patient during introduction. Our study also supports that person-centered care should be implemented at all levels of health care to make it possible for physical therapists to practice person-centered care. Keywords: Mechanical Insufflation--Exsufflation, Neuromuscular Disease, Physical Therapy, Qualitative

Introduction Physical therapy is generally considered to be largely a white profession in Western countries, likely due to a lack of workforce diversity, its global distribution, and leadership representation. (1) [...], Objective. Physical therapy is generally considered to be a white profession in Western nations. Australia's increasingly diverse population, driven largely by growth in immigration, invites Australian health systems to be responsive to factors that may impact on non-white Australian population's access to health care. Here, the authors sought to explore non-Indigenous Black people's perspectives of physical therapy in Australia. Methods. Eligible participants (n = 12) took part in semistructured, in-depth interviews and were prompted to discuss their experiences and perceptions of physical therapy. Interview data were analyzed using critical discourse analysis, underpinned by critical race theory. Results. Participants were on average 29.4 years (SD = 12.9) from diverse cultural and linguistic backgrounds. Participants described mostly positive experiences with physical therapists, but they noted that it was not widely accessed by their communities, with 2 key discourses underpinning these discussions. Discourse 1, "physiotherapy is a solution for white people," established physical therapy as primarily accessed by and welcoming of white people. "Whiteness" and the perpetuation of Western norms in physical therapy resulted in little consideration of other cultural practices. Participants' discussions also pointed to the intersections of systemic racism and social inequities such as low income and language barriers, impacting Black people's engagement with physical therapy. Discourse 2, "physiotherapists are white," was mostly concerned with how the perceived "whiteness" of professionals and lack of Black physical therapists impacts cultural safety and comfort when accessing physical therapy. Conclusion. Our results suggest that Westernization and whiteness persist among discourses surrounding physical therapy. Such discourses are likely to inform Black people's perceptions and experiences of physical therapy. Our analyses suggest avenues to enhance the cultural diversity of the profession and improve physical therapy accessibility for Black people in Australia by providing culturally appropriate material, including critical reflexivity, epistemic and cultural humility in the curricula, recruiting staff from diverse backgrounds, and providing outreach services to underserved populations. Impact. These findings highlight the need for increased cultural safety and diversity within the physical therapy profession to improve equity. Keywords: Black People, Culture, Discourse Analysis, Equity, Health Care Access, Physical Therapy

Introduction The expansion of postprofessional education (eg, residency and fellowship) in rehabilitation professions, such as physical therapy, occupational therapy, and nursing, places clinical rehabilitation organizations on the frontline of health [...], Objective. The objective of this observational study was to test a proposed conceptual model depicting the influence of personal and environmental attributes of clinical learning environments on rehabilitation professionals' career satisfaction and intention to stay with their current organization. The mediating effects of 2 loci of engagement were also assessed. Methods. Rehabilitation professionals (physical therapists, occupational therapists, speech-language pathologists, and registered nurses; n = 436) from 4 health care organizations in the Northeast, Southeast, and Midwest regions in the USA completed a battery of questionnaires related to personal attributes (resilience and orientation toward lifelong learning), environmental attributes (innovation support and basic psychological need satisfaction at work), loci of engagement (professional and organizational), career satisfaction, and intention to stay. Data were analyzed using structural equation modeling. Results. The measurement and structural model fit was acceptable. The greatest total effects on career satisfaction (r = .459) and intention to stay (r = .462) were observed through the influences of basic psychological need satisfaction, professional engagement, and organizational engagement. Orientation toward lifelong learning was negatively associated with career satisfaction (r = -.208) and intention to stay (r = -.154), but this was mitigated by organizational engagement (r = -.060 and - .134, respectively). Small but significant total effects were also observed between innovation support, professional and organizational engagement, and intention to stay (r = .144) and resilience, professional and organizational engagement, and career satisfaction (r = .110). Conclusion. Clinical learning environments that support rehabilitation professionals' basic psychological needs (autonomy, competency, and relatedness) are associated with greater career satisfaction and intention to stay. This association is further enhanced by organizational engagement and innovation support. Impact. Rehabilitation organizations interested in developing and retaining master adaptive learners should create clinical learning environments that reinforce rehabilitation professionals' sense of autonomy, competency, and relatedness, and are supportive on innovative behaviors. Keywords: Education: Postprofessional, Learning and Development, Professional Issues, Structural Equation Modeling, Workplace

Introduction Firearm violence is a major epidemic in the USA, leading to over 40,000 deaths and 85,000 injuries annually, 13 times more than other high-income countries. (1) In 2020, firearms [...], Keywords: Firearm Violence, Trauma Informed Care, Public Health Emergency, Education, Advocacy

Introduction Globally, health security is threatened by emerging diseases and environmental and behavioral risks. (1,2) People's experience of these health issues is significantly influenced by inequalities in access to health [...], Objective. The study's objective was to explore Filipino physical therapists' views on social responsibility and the competencies it entails. Methods. This study employed a constructivism-based qualitative design to inquire into the perspectives of physical therapist leaders and practitioners in the Philippines on Filipino physical therapists' social responsibility. Leaders were invited for their macro perspectives and influence on the profession; practitioners were invited to provide more practical viewpoints. Participants were interviewed one-on-one online. Interviews were transcribed, translated to English, and subjected to thematic analysis. Results. Sixteen participants agreed to share their perspectives. Six themes were generated. Participants viewed the social responsibility of physical therapists in the Philippines as a professional duty that requires altruistic and social justice motivations. Socially responsible actions should address pressing issues affecting Filipino people's access to physical therapy and experience of health. Conclusion. The social responsibility of physical therapists in the Philippines entails engaging in roles aside from clinical practice to contribute to Filipino people's attainment of health. This calls for the expansion of their ethical and practice frameworks to include addressing not only client issues, but also the wider societal barriers to equitable access to physical therapy and better experiences of health. Impact. This study contributes to professional discourse on the increasing importance of social responsibility in the physical therapist profession amidst increasing rehabilitation needs and growing concerns on health inequity locally and globally, especially as worsened by the novel coronavirus disease (COVID-19) pandemic. It informs the development of a societal practice framework for physical therapists in the Philippines and the desired changes in physical therapist policies and education to facilitate fulfillment of their societal obligations. Keywords: Education, Professional, Ethics, Professional Issues, Public Health, Social Responsibility

Disparities in research publications are common in the physiotherapy and rehabilitation fields. (1) A small proportion of published research arises from low-income and middle-income countries (LMICs), (1,2) home to 85% [...]

Introduction Chronic spine pain is a highly prevalent health condition, which has a profound impact on the lives of individuals affected and society. Up to 80% of the population experiences [...], Objective. Disparities exist in health care access, diagnosis, and treatment of chronic pain in Latino populations and other minority populations. Cognitive behavioral--based physical therapy (CBPT) interventions have been shown to be effective in predominantly non-Hispanic white populations with chronic spine pain. However, there is a need for culturally adapted CBPT interventions that focus on the conservative management of chronic spine pain. The primary purpose of the study described in this protocol is to test the efficacy of an adapted cognitive behavioral--based hybrid telerehabilitation intervention for Latino patients with chronic spine pain. Methods. A single-blind, 2-arm parallel group, superiority randomized clinical trial is planned to compare an adapted CBPT intervention to Usual Care physical therapy. Goal Oriented Activity for Latinos with chronic Spine pain (GOALS/Metas) is an 8-week hybrid telerehabilitation intervention that integrates guideline-based physical therapy and pain management interventions using cognitive behavioral approaches and has been adapted for Latino patients with chronic spine pain. Usual Care physical therapy will be administered based on institutional standards at the referring health center. Outcome measures will be evaluated preintervention and at 1-week, 3-months, and 6-months postintervention. The primary outcome is pain-related disability 1-week postintervention using the Brief Pain Inventory Pain Interference subscale. Secondary outcome measures include behavioral measures of functional activity, social participation, physical activity, and sleep. Determinants of treatment effect, including pain-related psychological measures, posture and movement, self-efficacy, treatment expectancy, and therapeutic alliance, will be included in the secondary moderation and mediation analyses. Impact. This clinical trial will provide information on the extent to which an adapted CBPT hybrid telerehabilitation intervention is effective in reducing pain-related disability for Latino patients with chronic spine pain. This information will be useful for clinicians to integrate in their practice, given the growing population of Latino patients who experience disparities in health care management of chronic pain. Keywords: Adapted, Chronic, Cognitive Behavioral, Hispanic, Latino, Low Back, Neck, Pain, Physical Therapy, Spine

Main Text/Introduction An old public health parable summarizes the challenges of preventing and managing illness and disease. (1) It starts with the protagonist standing next to a river when they [...], Social determinants of health are an emerging focus within physical therapist practice, research, education, and advocacy as a necessary condition for movement system health disparities. Fundamental cause theory suggests that the sociopolitical environment sets the context for individuals' socioeconomic positioning, which determines the availability of resources that are necessary for groups and individuals to maintain health. These resources include knowledge, money, power, prestige, and social connections. Yet, it is the hierarchical organization of society that dictates both the availability of socioeconomic resources and the ability of patients and clients to use those resources to promote and maintain movement system health. The presence of social hierarchies indicates the need for physical therapists to consider social power as a key determinant of movement system health. Consideration of social power in clinical initiatives and advocacy agendas would provide a framework for physical therapists to begin the dynamic, and often, adversarial process of breaking down social hierarchies and redistributing social power, rather than simply redistributing socioeconomic resources, in pursuit of societal transformation and community-building. This Perspective discusses social power as the fundamental driver of movement system health inequalities and explores the effects of social power on exposure, susceptibility, experience, and recovery related to movement system pathology--including the influence of social power on the ability of people to acquire socioeconomic resources and convert them to health-relevant resources. This perspective concludes with recommendations for physical therapists to identify and dismantle inequalities in social power through structural competency. Keywords: Social Determinants of Health, Social Power, Social Responsibility, Socioeconomic Factors

Introduction A detailed description of psychologically informed practice (PiP) and its origins (1) is presented in the accompanying paper in this issue. (2) In brief, PiP's most distinctive features are [...], Psychologically informed practice (PiP) includes a special focus on psychosocial obstacles to recovery, but research trials have revealed significant difficulties in implementing PiP outside of research environments. Qualitative studies have identified problems of both competence and confidence in tackling the psychosocial aspects of care, with a tendency to prefer dealing with the more mechanical aspects of care. In PiP, the distinction between assessment and management is not clear-cut. Analysis of the problem is part of the intervention, and guided self-management begins with the initial detective work by the patient, who is encouraged to develop successful and relevant behavior change. This requires a different style and focus of communication that some clinicians find difficult to enact. In this Perspective, the PiP Consultation Roadmap is offered as a guide for clinical implementation to establish a therapeutic relationship, develop patient-centered communication, and guide effective pain self-management. These strategies are illustrated through the metaphor of the patient learning to drive, with the therapist as a driving instructor and the patient as a student driver. For convenience, the Roadmap is depicted in 7 stages. Each stage represents aspects of the clinical consultation in a recommended order, although the Roadmap should be viewed as a general guide with a degree of flexibility to accommodate individual differences and optimize PiP interventions. It is anticipated that the experienced PiP clinician will find it progressively easier to implement the Roadmap as the building blocks and style of consultation become more familiar. Keywords: Psychologically Informed Practice, Pain, Communication

Introduction A commonly cited definition of population health is 'the health outcomes of a group of individuals, including the distribution of such outcomes within the group,' including 'health outcomes, patterns [...], Objective. Physical therapy is placing new emphasis on how the profession might contribute to improving population health. However, little is known about the nature of population-based practice (PBP) of physical therapists. Therefore, the purpose of this study was to develop a view of PBP from the perspective of physical therapists engaged in it. Methods. Twenty-one physical therapists participating in PBP were interviewed. Qualitative descriptive analysis was used to summarize results. Results. Most of the reported PBP was at the community and individual level, and the most common types of PBP were health teaching and coaching, collaboration and consultation, and screening and outreach. Three topic areas were identified (with respective themes): characteristics of PBP (meeting group or community needs, promotion and prevention, access, and movement), preparation for PBP (core vs elective, experiential learning, social determinants of health, and health behavior change), and rewards and challenges of PBP (intrinsic rewards, funding and resources, professional recognition, and complexity of behavior change). Conclusion. PBP in physical therapy presents practitioners with rewards and challenges as they work to improve the health of populations. Impact. Physical therapists who are currently engaged in PBP are, in effect, defining the role of the profession in improving health at a population level. The information in this paper will help the profession move from a theoretical view of the role of physical therapists in improving population health to understanding what this role looks like in practice. Keywords: Health Promotion, Physical Therapy, Population Health, Prevention, Qualitative Descriptive Analysis

Introduction In December 2019, a novel coronavirus named COVID-19 (Coronavirus Disease 2019) was discovered in Wuhan, China. COVID-19 is a respiratory virus that can cause fever, shortness of breath, cough, [...], Objective. Participation in life situations is a critical aspect of health recognized by the World Health Organization. Guidelines to prevent spreading of COVID-19 place older adults at risk of worsening participation. The purpose of this study was to identify the factors associated with participation during the COVID-19 pandemic among community-dwelling older adults living in Hamilton, Ontario, Canada. Methods. Participants were recruited from identified census dissemination areas in Hamilton. Participants completed surveys either by phone or online during the months of May to August 2020. Measures were organized into factors related to body functions and structures, activities, participation, as well as personal and environmental contextual factors using the International Classification of Functioning, Disability, and Health (ICF) framework. Multivariable regression analysis was conducted to identify factors associated with participation as measured by the Late-Life Disability Instrument's (LLDI) frequency and limitations scales. Results. A total of 272 older adults completed the survey (78 [7.3] years; 70% female). Use of a walking aid, driving status, perceived mental health status, nutrition risk, and physical function explained 48.2% of the variance observed in the LLDI-frequency scale scores. Use of a walking aid, driving status, perceived mental health status, receiving health assistance, and physical function explained 38.5% of the variance observed in the LLDI-limitation scale scores. Conclusion. Results highlighted factors across multiple ICF domains that are associated with participation restriction among a sample of community-dwelling older adults during the pandemic. Participation during the pandemic was greatest in those that were able to walk without needing to use a walking aid, being a licensed and current driver, perceiving good to excellent mental health, and having greater physical function. Impact. Our findings contribute to the literature on older adult participation during lockdowns, restrictions, pandemics, and/or other similar circumstances. Keywords: Community-Dwelling, COVID-19, Driving, Mental Health Participation in Life Situations, Older Adults

Introduction Low back pain (LBP) is the leading cause of global disability. (1,2) An estimated 16% of the Australian population lives with this condition, and approximately 70% to 90% of [...], Objective. The shift toward patient-centered care in physical therapy fostered a deeper consideration of power-sharing in clinical interactions. Elements of reciprocity may enhance such power considerations between physical therapist and patients, but there has been little investigation into how reciprocity is enacted in physical therapy, its value, and how to improve it if required. This study investigates forms of reciprocity during physical therapist-patient interactions in low back pain (LBP) care with the aim of enhancing patient-centered approaches. Methods. The qualitative design involved (1) ethnographic observations at a fee-for-service practice in Australia, and (2) reflexive discussions between researchers and participating clinicians. To understand reciprocity, the analysis drew from the concepts of "accepting'"(or "blocking") "offers" that have been previously applied to physical therapy interactions. The analysis is a sub-study using a larger dataset and analyses in which we partnered with physical therapists and people living with LBP. Results. Forty-nine observations and 13 reflexive discussions were undertaken with 42 people with LBP and 10 physical therapists. Analysis developed 3 themes suggesting that forms of reciprocity depended on physical therapists accepting or blocking patients' offers, inviting patients to make an offer, and offering personal stories. These elements of reciprocity are relevant to power-sharing during interactions and may impact patient-centered care. Conclusion. Our results suggest that attending to forms of reciprocity can help physical therapists shift power in clinical interactions. By inviting and accepting "offers," physical therapists may build collaborative interactions, support individuals to guide the treatment narrative, and shift away from biomedically centered management approaches. Such recommendations create reciprocal environments that might enhance patient-centered care. Impact. This is one of the few studies to explore how reciprocity is enacted in interactions between physical therapists and s with LBp. Our findings highlight how engaging with the concept of reciprocity could assist with sharing power, improving physical therapist-patient relationships, and enhancing patient-centered care. Keywords: Low Back Pain, Patient-Centered Care, Professional Issues, Professional-Patient Relations, Reciprocity

It is through storytelling that human beings make sense of their lives, interpret events, and shape their actions. Health care professionals listen to patient stories every day. They bear witness [...]

Introduction The demographic of older adults living in rural areas of the United States is changing. In fact, the most rapidly aging areas in the United States are rural communities, [...], Keywords: Cultural Humility, Education: Physical Therapist Students, Health Policy, Older Adults, Rural

Introduction The twin crises of the COVID-19 pandemic and the deadly and harmful effects of systemic racism create a crucible for change with the imperative to disrupt the status quo [...], This Perspective issues a challenge to physical therapists to reorient physical therapist education in ways that directly address the crises of COVID-19 and systemic racism. We advocate that professional education obligates us to embrace the role of trusteeship that demands working to meet society's needs by producing graduates who accept their social and moral responsibilities as agents and advocates who act to improve health and health care. To achieve this, we must adopt a curriculum philosophy of social reconstruction and think more deeply about the why and how of learning. Currently, health professions education places strong emphasis on habits of head (cognitive knowledge) and hand (clinical skills) and less focus on habits of heart (professional formation). We believe that habits of heart are the essential foundations of the humanistic practice needed to address health inequities, find the moral courage to change the status quo, and address imbalances of power, privilege, and access. A social reconstruction orientation in physical therapist education not only places habits of heart at the center of curricula, but it also requires intentional planning to create pathways into the profession for individuals from underrepresented groups. Adopting social reconstructionism begins with a faculty paradigm shift emphasizing the learning sciences, facilitating learning, metacognition, and development of a lifelong master adaptive learner. Achieving this vision depends not only on our ability to meet the physical therapy needs of persons with COVID-19 and its sequalae but also on our collective courage to address injustice and systemic racism. It is imperative that the physical therapy community find the moral courage to act quickly and boldly to transform DPT education in ways that enable graduates to address the social determinants of health and their systemic and structural causes that result in health disparities. To succeed in this transformation, we are inspired and strengthened by the example set by Geneva R. Johnson, who has never wavered in recognizing the power of physical therapy to meet the needs of society. Keywords: Education: Professional, Professional Issues, Social Responsibility

Introduction Expectations are defined as strong beliefs that something will or should happen. (1) Recovery expectations, also known as predicted outcomes, are defined as an individual's belief in the potential [...], Objective. The purpose of this study was to determine the association between baseline patient recovery expectations and outcomes following physical therapy care. Methods. PubMed, CINAHL Complete, PEDro, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO were searched from inception to February 2021. Concepts represented in the search included physical therapy, patient expectations, patient outcomes, and their relevant synonyms. Two reviewers independently screened studies of article abstracts and full texts. Eligibility criteria included English language studies that evaluated adults seeking physical therapist intervention for any health condition where both patient outcome (recovery) expectations and functional or other outcome measures were reported. Methodologic standards were assessed using the Critical Appraisal Skills Program criteria. Data were extracted using a custom template for this review with planned descriptive reporting of results. Vote counting was used to measure reported outcomes. Results. Twenty-one studies were included in this review, representing 4879 individuals. Studies were most commonly prospective cohort studies or secondary analyses of controlled trials. Varied expectation, outcome, and statistical measures that generally link patient recovery expectations with self-reported outcomes in musculoskeletal practice were used. Conclusion. Patient recovery expectations are commonly associated with patient outcomes in musculoskeletal physical therapy. Impact. Evidence supports measuring baseline patient expectations as part of a holistic examination process. Keywords: Outcomes Measurement, Patient Examination, Patient Expectations, Psychosocial

Introduction Caring for a family member who has a severe disability is hard and can often last a lifetime. (1-4) This is especially true for families of children with severe [...], Objective. The purpose of this study was to explore the lived experience of parents who care for children with cerebral palsy who function at a Gross Motor Function Classification System Level V, their beliefs about pain and non-pain-related emotional distress, and what it means to provide care and comfort. Methods. A phenomenological research design was used. Eleven participants were involved in this study. Pilot interviews informed the interview guide. Data were collected via participant journals and semi-structured interviews and analyzed using van Manen's framework for understanding experience. Trustworthiness criteria were met through a variety of strategies to ensure a rigorous research process. Results. Four themes were revealed in this study: "life is hard, heavy with burden, worry, and love," "remarkable," "identity transformation and empowerment," and "living a life that is planned, forced with structure and without spontaneity." Conclusion. Caring for a child with lifelong needs is complex and requires a sensitive awareness of the contextual factors that impact daily decisions and routines. Understanding the lived experiences of parents who care for children with cerebral palsy Gross Motor Function Classification System Level V is necessary to provide psychologically informed, family-centered care. Comfort theory is presented as a framework for understanding what factors influence comfort and well-being. Understanding the complex nature of comfort for an individual can lead to greater understanding and empathy-driven care. These results will provide a foundation for future studies that aim to enhance pediatric physical therapist care through provider empathy and understanding. Impact. Caregiving parent experiences are impactful and play a large role in the life of children with developmental disabilities. Research exploring the lived experience of caregivers may enhance empathy-driven, psychologically informed, family-centered physical therapist care throughout the life course. Lay Summary. If you are a parent who cares for a child with severe cerebral palsy, you have unique experiences that impact day-to-day activities and lifelong planning for your family and child. Keywords: Caregivers, Cerebral Palsy, Child, Developmental Disabilities, Disabled Children, Pain

Introduction As humans, we are inherently social organisms, and, as a consequence, our social environment and life experiences can profoundly impact our health and survival. (1,2) These social experiences, particularly [...], Human health is affected by lived experiences, both past and present. The environments we encounter throughout our lives, therefore, shape how we respond to new challenges, how we maintain a healthy immune system, and even how we respond to treatment and rehabilitation. Early in life and throughout adulthood, social experiences--such as exposure to various forms of adversity--can alter how cells in our body function, with far-reaching consequences for human health, disease, and treatment. This Perspective highlights studies from an ever-growing body of literature on the social determinants of health, with a focus on exposure to social adversities, such as social isolation, discrimination, or low social status, experienced both early in life and adulthood and how they variably impact health. By focusing on recent observational studies in humans and experimental studies on social nonhuman animals, this article details how social adversity can become biologically embedded in our cells at the molecular level. Given that humans are social animals, it is no surprise that social adversity can negatively impact our health, and experimental animal studies have helped us to uncover some of the causal mechanistic pathways underlying the link between social adversity and health outcomes. These molecular consequences can have far-reaching implications and, when combined with our growing knowledge on the social determinants of health, should inform how we approach treatment and rehabilitation. Keywords: Genomics, Molecular, Rehabilitation, Social Determinants of Health

Introduction Population health gained prominence in Canada in the mid-1990s, emerging as a conceptual framework for 'thinking about why some people are healthier than others' and leveraging this information to [...], Health starts where we live, learn, work, and play. Population health represents a unifying paradigm for understanding systematic variations in health and related factors, informing integrated action, and reducing health disparities. The pathways connecting social, environmental, and structural factors and various health outcomes have been illuminated by the emergence of epigenetic and epigenomic research, further bolstering the value of population health perspectives in supporting clinical practice, community-based programs, and societal policies. The purpose of this perspective is to consider the placement of epigenetic and epigenomic insights within a population health framework to strengthen the physical therapy profession's understanding of variations in health, inform integrated action, and further justify our role in reducing health-related disparities. Keywords: Epidemiologic Factors, Epigenetics, Epigenomics, Health Disparities, Integrated Action, Population Health

Introduction Connecting health professional education content to reflect community needs requires curricular goals derived from, and accountable to, society. (1) Integrating population health perspectives throughout physical therapist education is an [...], The future of health care professional education is moving from a focus on the individual to embrace the health of the larger society. The COVID-19 pandemic has further highlighted the connection between social determinants and the health of populations. There are frameworks and competencies to support the delivery of population health content in the entry-level Doctor of Physical Therapy (DPT) curriculum. Three options for integrating population health content into the DPT curriculum are presented: (1) threading the content throughout the curriculum, (2) concentrating the content in 1 or 2 identified courses, and (3) offering elective courses. Each of these strategies has benefits and challenges, but threading the content throughout the curriculum provides the best opportunity to reinforce population health competencies across populations and practice settings. Experiential learning using authentic scenarios provides an ideal opportunity for students to understand population health concepts in a real-world context. Activities that incorporate interaction with other health professions broaden students' perspectives of the role of different professions for achieving population health goals. Examples of learning activities are included in 3 competency areas, Foundations of Population Health, Prevention and Health Promotion, and Health Policy. Current societal issues provide an opportunity to enhance population health education from a meaningful perspective for students. The topic of health equity presents an opportunity to tie social and political factors of population health to social justice and health outcomes. Similarly, the COVID-19 pandemic puts issues of mental health, health disparities, and health systems front and center in our understanding of population health. Impact. Health care practitioners are looking at health through the lens of health equity and acknowledging the impact of social and political determinants on health to address health disparities, decrease health care expenditures, and respond to changes necessitated by pandemics such as COVID-19. As health care systems and practices are rethought and reconstructed, the intentional integration of population health principles woven into the fabric of professional education is a critical component of preparing future providers. This article describes how population health concepts can be meaningfully embedded into the DPT curriculum along with providing realistic examples and activities. Keywords: Curriculum, Health Policy, Health Promotion, Physical Therapist Education, Population Health, Primary Prevention

Introduction Approximately 795,000 people in the United States experience a stroke each year, making it one of the leading causes of long-term disability in the United States. (1) Community participation [...], Objective. It was previously found that balance self-efficacy mediated the relationship between physical capacity and participation after stroke. The effect of other factors that influence participation, such as depression, on this relationship has not been explored. This study examined the effect of symptoms of depression on the mediated relationship between physical capacity and participation by balance self-efficacy in individuals after stroke. Methods. In this cross-sectional study, 282 persons with chronic stroke (>6 months) were classified as having either low or high Geriatric Depression Scale scores. This study used a multiple group structural equation model to test moderated mediation by comparing a constrained model (indicating no effect of depression on the mediation) and an unconstrained model (indicating an effect of depression on the mediation). The models were compared using a chi-squared difference test. Results. The chi-squared difference test suggested that the unconstrained model was a better fit, indicating that depressive symptoms moderated the mediated relationship between physical capacity and participation ([chi square][.sub.(3, N =282)] = 9.0). In the Low Depression group, a significant indirect effect indicated that balance self-efficacy did mediate the relationship between physical capacity and participation. There was no significant indirect effect in the High Depression group. Conclusion. The results suggest the relationship between physical capacity and participation appears to be mediated by balance self-efficacy in individuals after stroke with low reports of depressive symptoms, but in those with high reports of depressive symptoms, physical capacity and balance self-efficacy are unrelated to participation. Impact. Targeting balance self-efficacy to improve post-stroke participation may be beneficial only for individuals with low reports of depression. In individuals after stroke with high reports of depression, treatment should include and emphasize the treatment of those depressive symptoms. Additional work further examining these complex relationships is warranted. Keywords: Community Participation, Depression, Mediation, Moderation, Self-Efficacy, Stroke, Structural Equation Model

Our nation has been shaken, awakened from a long slumber in which many of us dreamed that we were close to a postracial state. More than a half century after [...], Keywords: American Physical Therapy Association: Policies and Standards, Antiracism, Diversity, Education: Physical Therapist Students, Equity, Health Services Accessibility, Inclusion, Institutional Racism, Positions, Social Determinants of Health, Social Justice

Introduction Parkinson disease (PD) is a neurodegenerative movement disorder characterized by rigidity, bradykinesia, tremor, and postural instability. (1) Physical activity and exercise are essential complements alongside pharmacological treatment in the [...], Objective. The purpose of the study was to determine the impact of novel coronavirus 2019 (COVID-19) restrictions on community-based exercise classes for people with Parkinson disease (PD) and their instructors. Methods. Data were collected via custom-designed electronic surveys for people with PD and class instructors who reported attending or teaching PD-specific exercise class >1 time/week for >3 months prior to pandemic restrictions (March 2020). The PD group also completed the Godin Leisure-Time Questionnaire, Self-Efficacy for Exercise scale, Schwab-England scale, and Parkinson's Disease Questionnaire 8. Results. Eighty-seven people with PD (mean = 70 [7.3] years old) and 43 instructors (51 [12.1] years old) from the United States completed surveys (October 2020 to February 2021). Mean Schwab-England (84 [16]) and Parkinson's Disease Questionnaire 8 (21 [15]) scores indicated low-to-moderate disability in the PD group. Ninety-five percent of the PD group had COVID-19 exposure concerns, and 54% reported leaving home 50% reported decreased exercise quantity/intensity compared with pre-COVID. There was decreased in-person and increased virtual class participation for both groups. The top in-person class barrier for the PD (63%) and instructor (51%) groups was fear of participant COVID-19 exposure. The top virtual class barriers were lack of socialization (20% of PD group) and technology problems (74% of instructor group). Conclusion. During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and decreased exercise quantity and intensity. Virtual classes may not fully meet the needs of people with PD, and primary barriers include technology and lack of socialization. Impact. As COVID-19 restrictions wane, it is imperative to help people with PD increase exercise and activity. The barriers, needs, and facilitators identified in this study might help inform approaches to increase participation in exercise and activity for people with PD. Lay Summary. During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and a decrease in exercise quantity and intensity. If you have PD, virtual classes might not fully meet your needs. Primary barriers may include technology problems and lack of social interaction. Keywords: Exercise, Health Care Surveys, Movement Disorders, Neurology, Parkinson Disease

Background The COVID-19 pandemic has negatively impacted the health of people from communities of color and people of limited socioeconomic means in a disproportionate way due to social determinants of [...], The COVID-19 pandemic has negatively impacted the health of people from communities of color and people of limited socioeconomic means in a disproportionate way due to social determinants of health (SDoH). The Centers for Disease Control defines SDoH as the "conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes." A related construct, social determinants of learning (SDoL), includes contextual conditions and variables that impact students' ability to optimally participate in their education, including academic and clinical development. SDoL directly impact students' ability to participate in the educational process. During the COVID-19 pandemic, students struggling with SDoH and, by extension SDoL, may be more likely to have sick family members, caregiving responsibilities, food and housing insecurity, and obligations to supplement lost family wages. SDoL are also influenced by individual experiences within and outside of the classroom. Beyond bringing this matter to the attention of our profession, especially clinical and academic educators, we must take action to reach and support students who are at higher academic risk due to the SDoL. The purpose of this paper is to (1) define SDoL, (2) explain how SDoL are impacting doctor of physical therapy and physical therapist assistant students, and (3) discuss actions that physical therapists and physical therapist assistants can take to mitigate the effects of SDoL on current doctor of physical therapy and physical therapist assistant students. Impact. This Perspective is one of the first explorations of how SDoL affect physical therapy students during the pandemic and provides concrete suggestions on how educators in both academic and clinical settings can help students succeed when they are negatively affected by SDoL. Keywords: Education: Physical Therapist Assistant Students, Education: Physical Therapist Students, Professional Issues, Socioeconomic Factors

Introduction Since 2013, the American Physical Therapy Association's (APTA's) Vision Statement for the profession has been, 'transforming society by optimizing movement to improve the human experience.' (1) This vision, guided [...], The American Physical Therapy Association's Vision Statement for the profession is guided by principles of innovation, access, equity, and advocacy, and calls on physical therapists to stretch their influence beyond the walls of the clinic and the individuals they treat. Access and equity are problems that span multiple health care professions and entities; yet, addressing social determinants of health is a paradigm shift that clinicians need continued support to achieve. This article has 2 objectives: (1) to define the Fundamental Cause Theory and the Socioecological Model within the context of physical therapy in order to promote best clinical practice, and (2) to apply the concept of "fundamental interventions" in clinical practice to mitigate the negative impact of downstream effects of social determinants of health across levels of the Socioecological Model--individual, interpersonal, institutional, community, and societal. This theoretical lens provides the conceptual framework necessary for physical therapists to think creatively about ways to change their practice in their own contexts to impact the life of individual patients and transform the movement health of society. Impact. As health care providers, physical therapists have a responsibility to make every effort to meet the needs of their patients and optimize movement health in society; yet significant structural and systemic barriers often prevent patients from reaching their fullest potential. Clinicians can no longer subscribe to a narrow scope of practice focused on individual attainment of therapy goals. This Perspective discusses Fundamental Cause Theory and the Socioecological Model theoretical frameworks that can help physical therapists develop, test, and implement functional interventions to address the needs of society as a whole. Keywords: American Physical Therapy Association, Policies, Standards, Measurement, Basic Theory, Science, Positions, Public Health, Social Responsibility

Background The Coronavirus Disease 2019 (COVID-19) pandemic begun in Wuhan in December 2019 and spread rapidly across the globe, causing millions of deaths. (1) Frontline health care workers (HCWs), including [...]

Introduction The incidence and prevalence of neck pain has risen in recent years, the latter increasing with age (.1,2) This musculoskeletal disorder may be associated with whiplash injuries, myofascial pain [...], Objective. Given the complex and unclear etiology of neck pain, it is important to understand the differences in central sensitization as well as psychosocial factors in individuals with chronic neck pain and healthy controls. The purpose of this study was to benchmark differences in central sensitization, psychosocial factors, and range of motion between people with nonspecific chronic neck pain and healthy controls and to analyze the correlation between pain intensity, neck disability, and psychosocial factors in people with chronic neck pain. Methods. Thirty individuals with chronic neck pain and 30 healthy controls were included in this case--control study. Outcome measures were as follows: central sensitization (pressure pain threshold, temporal summation, and conditioned pain modulation), psychosocial factors (depressive symptoms, pain catastrophizing, and quality of life), and active cervical range of motion. Results. People with neck pain had lower local pressure pain threshold, a decrease in conditioned pain modulation, more depressive symptoms, greater pain catastrophizing, lower quality of life, and reduced range of motion for neck rotation compared with healthy controls. In people with neck pain, moderate correlations were observed between pain intensity and quality of life ([rho] = -0.479), disability and pain catastrophizing ([rho] = 0.379), and disability and quality of life ([rho] = -0.456). Conclusion. People with neck pain have local hyperalgesia, impaired conditioning pain modulation, depressive symptoms, pain catastrophizing, low quality of life, and reduced active range of motion during neck rotation, which should be taken into account during assessment and treatment. Impact. This study shows that important outcomes, such as central sensitization and psychosocial factors, should be considered during assessment and treatment of individuals with nonspecific chronic neck pain. In addition, pain intensity and neck disability are correlated with psychosocial factors. Keywords: Chronic Pain, Neck Disability, Neck Pain, Pain Modulation, Pain Threshold, Pressure Pain Threshold

Within communities, people with disabilities (PWD) frequently engage with physical therapy through service provision, as volunteer patients in classrooms, as examples in case studies, or as friends and family within [...]

Introduction In March 2020, the World Health Organization declared the coronavirus outbreak as a pandemic and a public health emergency due to its widespread community transmission. (1,2) As of July [...], Objective. The purpose of this study was to investigate the physical therapy process of care, clinical practices, and the selfreported psychosocial impact of working during the 2020 pandemic on physical therapists and physical therapist assistants. Methods. An electronic survey including closed and open-ended questions was distributed to physical therapists employed in a range of health care settings across the United States. Results. Physical therapy use and process of care varied across settings. Feasibility of performing an assessment was the main driver for selection of outcome measures. Interventions were mainly geared toward improving respiratory function and deconditioning. Prone patient positioning, now commonplace, was used infrequently by therapists in acute care prior to coronavirus disease 2019 (COVID-19). Similarly, outpatient and home care settings noted an increase in the use of respiratorydriven interventions such as incentive spirometry and breathing exercises. Qualitative data analysis revealed both physical barriers (personal protective equipment [PPE]) and social barriers to care. Therapists noted challenges in discharge planning and patient/family education due to the impact of social isolation. They also noted difficulty maintaining productivity standards because of additional time spent in changing PPE and following safety measures. Participants dealt with rapid changes in their role, changing productivity standards, and needing to increase their knowledge in a short amount of time. Conclusion. Physical therapy use varied widely across settings. Despite some concern for personal health, respondents felt that the COVID-19 pandemic increased a sense of togetherness among team members and promoted greater appreciation for life and work. Impact. This exploration of the process of care and current clinical practices across settings provides important knowledge about the role of physical therapists and physical therapist assistants in the care of patients with COVID-19. Gaining an understanding of the psychosocial impact of the pandemic among therapists could assist in creating solutions to better support clinicians' well-being. Keywords: Acute Care, Critical Illness, Physical Therapy Techniques

Introduction Low back pain (LBP) is a highly prevalent condition and the leading cause of disablement worldwide. (1) Studies show 20% to 30% of those with LBP who seek health [...], Objective. Research supports the relevance of the therapeutic alliance (TA) between patients and physical therapists on outcomes, but the impact of TA during routine physical therapist practice has not been quantified. The primary objective of this study was to examine the relationship between TA assessed during a physical therapy episode of care for patients with low back pain and functional outcome at the conclusion of care. The secondary objective was to examine psychometric properties of the Working Alliance Inventory-Short Revised (WAI-SR) form, a patient-reported TA measure. Methods. This study was a retrospective analysis of prospectively collected data from 676 patients (mean [SD] age = 55.6 [16.1] y; 55.9% female) receiving physical therapy for low back pain in 45 outpatient clinics from 1 health system in the United States. Participating clinics routinely collect patient-reported data at initial, interim, and final visits. The lumbar computer-adapted test (LCAT) was used to evaluate functional outcome. The TA was assessed from the patient's perspective at interim assessments using the WAI-SR, bivariate correlations were examined, and regression models were examined if interim WAI-SR scores explained outcome variance beyond a previously validated multivariate prediction model. Internal consistency and ceiling effects for the WAI-SR were examined. Results. Interim WAI-SR scores were not correlated with patient characteristics or initial LCAT, but they were correlated with final LCAT and LCAT change from initial to final assessment. WAI-SR total score (adjusted [R.sup.2] = 0.36), and Task (adjusted [R.sup.2] = 0.38) and Goal subscales (adjusted [R.sup.2] = 0.35) explained additional variance in outcome beyond the base model (adjusted [R.sup.2] = 0.33). Internal consistency was higher for WAI-SR total score ([alpha] = .88) than for subscales ([alpha] = .76-.82). Substantial ceiling effects were observed for all WAI-SR scores (27.2%-63.6%). Conclusion. Findings support the importance of TA in physical therapist practice. Measurement challenges were identified, most notably ceiling effects. Impact. This study supports the impact of the patient-physical therapist alliance on functional outcome. Results extend similar findings from controlled studies into a typical physical therapist practice setting. Better understanding of the role of contextual factors including the therapeutic alliance might be key to improving the magnitude of treatment effect for discrete physical therapist interventions and enhancing clinical outcomes of physical therapy episodes of care. Keywords: Low Back Pain, Therapeutic Alliance, Contextual Factors

Introduction The severe acute respiratory syndrome coronavirus 2, known as COVID-19, is a discovered ribonucleic acid coronavirus identified from patients with unexplained pneumonia in Wuhan, China, in December 2019. (1) [...], Objective. Knowledge of the experiences of health care professionals who have actively worked on the first line of the COVID-19 pandemic could help to identify specific professional duties focused on health assistance objectives. No qualitative study has yet been published, to our knowledge, describing the experience of physical therapists during the COVID-19 pandemic. The purpose of this study was to describe and explore the experiences and perspectives of physical therapists working in public hospitals in Madrid, Spain, during the COVID-19 pandemic. Methods. A qualitative exploratory study was conducted based on an interpretive framework. Thirty physical therapists working at 11 national public hospitals during the COVID-19 outbreak were recruited by purposeful sampling and snowball techniques. In-depth interviews and researchers' field notes were used to collect data. Interviews were transcribed verbatim. Inductive thematic analysis was used to identify emerging themes. Results. After identifying 3912 codes and 13 categories, 3 themes emerged. The first theme was "call of duty"; as COVID-19 infection dramatically spread, the hospitals were contaminated and overwhelmed, and all floors were converted into COVID-19 wards. The second theme was "working in wartime." Every day, therapists were given "the war report," receiving their orders, meeting protective personal equipment requirements, and confronting fear. The third theme was "when I arrive at home." Working during the pandemic had an impact on the therapists' families and the information shared with them. Conclusions. Physical therapists described the COVID-19 outbreak as an apocalyptic and unexpected war. Comprehensive support is needed for all frontline health care professionals. The COVID-19 outbreak revealed that health care systems were not prepared for a pandemic. Impact. To our knowledge, this is the first qualitative study to be published describing the experience of physical therapists during the COVID-19 pandemic. Keywords: COVID-19, Pandemic, Physical Therapy, Health Care Professional, Qualitative

Telerehabilitation (TR), the delivery of rehabilitation services remotely by means of telecommunications technologies, emerged more than 30 years ago but was largely underutilized despite growing evidence for its potential. (1-3) [...]

Recommendations on physical activity (PA) to prevent disability and comorbidity in people with chronic conditions include a minimum of 150 min/wk of moderately intense aerobic exercise, or 75 min/wk of [...], Objective. A few studies with a qualitative design have addressed physical activity (PA) maintenance in people with rheumatoid arthritis (RA), but none of them focused specifically on maintenance of PA according to public health recommendations. The purpose of this study was to describe perceptions of PA maintenance during the second year of an outsourced 2-year support program among people with RA. Methods. For this descriptive design with a qualitative inductive approach, semi-structured interviews were conducted with 18 participants with RA (3 men and 15 women). Variation in age, disease duration, activity limitation, pain, levels of PA, and PA maintenance was targeted through strategic sampling. Qualitative content analysis was used, and a pattern of theme, subthemes, and categories was constructed based on the participants' perceptions of PA maintenance. Results. A main overarching theme, "A necessary investment in future health"--with 3 subthemes of dedication, awareness, and affinity--was identified as participants' perceptions of PA maintenance. Eight categories further described are a changed mindset, habits, commitments, monitoring, insights in PA, health gains, social support, and PA context. Conclusions. PA according to public health recommendations was perceived as a true investment in future health and wellness requiring dedication, awareness, and affinity. To promote PA maintenance, physical therapists working with people with chronic conditions should consider strengthening these prerequisites by targeting patients' negative attitudes to PA, supporting their creation of PA habits to incorporate in daily routines, introducing monitoring of PA intensity, supporting development of PA self-regulation skills, and providing suitable gym facilities with the possibility of peer support.