Search

Outcome measures (OMs) have been emphasized by healthcare professions to optimize patient examination; however, a lack of regular use of OMs exists. The purpose of this study was to describe the outcome of a knowledge translation (KT) intervention to increase the use of OMs by physical therapists in an inpatient rehabilitation setting. A quasi-experimental pre-post study design was used. A multi-component KT intervention including education, organizational support, documentation, and environmental changes to increase the use of five OMs was implemented. Audit and feedback (A&F) was added to the KT intervention at month 6. Documented use of OMs was determined through manual chart audit (n = 864) and electronically (n = 2599). Regression analyses were used to identify factors associated with OMs use across time and diagnoses. Following the addition of A&F to the KT intervention at month 6, there was a significant increase in the odds of OMs use across all time intervals (months 6–12, 12–18, 18–24)(Odds Ratio (OR) 5.9, 95% Confidence Interval (CI) 4.1–8.5; OR 8.5, 95% CI 6.0–12.1; OR 10.8, 95% CI 7.6–15). There was also a significant increase in the odds of documenting OMs on individuals with neurological diagnoses (OR 0.3, 95% CI 0.5–0.8). This KT intervention increased and sustained OMs use over 24-months. This intervention can be replicated to improve the evidence-based practices of physical therapists. [ABSTRACT FROM AUTHOR]

Background: PTNow.org is an evidence-based, on-line portal created by a professional membership association to promote use of evidence in practice and to help decrease unwarranted variation in practice. The site contains synthesis documents designed to promote efficient clinical reasoning. These documents were written and peer-reviewed by teams of content experts and master clinicians. The purpose of this paper is to report on the content and construct validity as well as usability of the site.Methods: Physical therapist participants used clinical summaries (available in 3 formats--as a full summary with hyperlinks, "quick takes" with hyperlinks, and a portable two-page version) on the PTNow.org site to answer knowledge acquisition and clinical reasoning questions related to four patient scenarios. They also responded to questions about ease of use related to website navigation and about format and completeness of information using a 1-5 Likert scale. Responses were coded to reflect how participants used the site and then were summarized descriptively. Preferences for clinical summary format were analyzed using an analysis of variance (ANOVA) and a Dunnett T3 post hoc analysis.Results: Seventeen participants completed the study. Clinical relevance and completeness ratings by experienced clinicians, which were used as the measure of content validity, ranged from 3.1 to 4.6 on a 5 point scale. Construct validity based on the information on the PTNow.org site was supported for knowledge acquisition questions 66 % of the time and for clinical reasoning questions 40 % of the time. Usability ratings for the full clinical summary were 4.6 (1.2); for the quick takes, 3.5 (.98); and for the portable clinical summary, 4.0 (.45). Participants preferred the full clinical summary over the other two formats (F = 5.908, P = 0.007). One hundred percent of the participants stated that they would recommend the PTNow site to their colleagues.Conclusion: Prelimary evidence supported both content validity and construct validity of knowledge acquisition, and partially supported construct validity of clinical reasoning for the clinical summaries on the PTNow.org site. Usability was supported, with users preferring the full clinical summary over the other two formats. Iterative design is ongoing. [ABSTRACT FROM AUTHOR]

Background: As the population ages, the incidence of neurological diseases associated with aging will increase. Impairments related to neurological disease include spasticity, pain, joint contracture, weakness, and loss of mobility. Manual therapy, skilled hand movements performed by physical therapists, has been found to decrease pain and increase tissue extensibility. The purpose of this article was to review the literature on the effects of manual therapy to manage or improve the impairments and functional limitations related to neurological diseases in the older adults. Results: Literature on the effects of manual therapy on spasticity, range of motion/ joint contracture, pain, strength, gross mobility, fine motor skills, and dysphagia were included in this review. Manual therapy treatments included stretching, passive movements, joint mobilizations, massage, proprioceptive neuromuscular facilitation, neurodevelopmental technique, and gait training. Conclusion: There was limited evidence on the effects of manual therapy to treat and prevent joint contracture. Stretching, combined with Botox (botulinum toxin A), was found more effective at improving range of motion than stretching alone. Joint mobilizations showed immediate improvements in range of motion and balance, but higherquality studies investigating the long-term impact of joint mobilization on patient function need to be conducted. The amount of therapy (dosage) plays a role in recovery of function. Continued research is needed to determine the best practice for the use of manual therapy for individuals with neurological disease. [ABSTRACT FROM AUTHOR]