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Survivors of critical illness, including those with COVID-19, are likely to experience post-intensive care syndrome (PICS). PICS involves a constellation of physical, cognitive, and mental health problems that can occur following hospitalization in an intensive care unit (ICU). This focused review describes the impact of PICS on an individual’s function, societal participation, and family. Specific evidence-based screening tools for in-home identification of the deficits associated with PICS are recommended. Recognition of PICS through early screening by home health care providers is crucial in order to assemble the physical rehabilitation, mental health, and community resources needed to mitigate the long-term effects of COVID-19 and other critical illnesses. This review concludes with further PICS resources for community-based providers to enhance their knowledge and expertise and to prepare them for caring for COVID-19 and other critical illness survivors.

Background Post–intensive care syndrome (PICS) is a constellation of new or worsening impairments in physical, mental, or cognitive abilities or a combination of these in individuals who have survived critical illness requiring intensive care. Purpose The 2 purposes of this systematic review were to identify the scope and magnitude of physical problems associated with PICS during the first year after critical illness and to use the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to elucidate impairments of body functions and structures, activity limitations, and participation restrictions associated with PICS. Data Sources Ovid MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL Plus with Full Text (EBSCO), Web of Science, and Embase were searched from inception until March 7, 2017. Study Selection Two reviewers screened titles, abstracts, and full text to independently determine study eligibility based on inclusion and exclusion criteria. Data Extraction Study methodological quality was assessed using the Newcastle–Ottawa Scale. Data describing study methods, design, and participant outcomes were extracted. Data Synthesis Fifteen studies were eligible for review. Within the first year following critical illness, people who had received intensive care experienced impairments in all 3 domains of the ICF (body functions and structures, activity limitations, and participation restrictions). These impairments included decreased pulmonary function, reduced strength of respiratory and limb muscles, reduced 6-minute walk test distance, reduced ability to perform activities of daily living and instrumental activities of daily living, and reduced ability to return to driving and paid employment. Limitations The inclusion of only 15 observational studies in this review may limit the generalizability of the findings. Conclusions During the first year following critical illness, individuals with PICS experienced physical impairments in all 3 domains of the ICF.

INTRODUCTIONThe development of interpersonal skills is critical for the professional development of physical therapist (PT) students.3'4 Interpersonal skills include both verbal and nonverbal skills necessary for communicating and interacting with patients, both expressively and receptively.4 One method of developing interpersonal skills in physical therapist students is through integrated clinical experiences (ICEs), which is defined as students working with patients for more than 20 hours with faculty serving as clinical instructors (CIs). This method is modeled by physical therapist education programs at Clarke University5 and Nova Southeastern University.6 The American Council of Academic Physical Therapy (ACAPT)7 defines an ICE as "a clinical education experience that occurs during an academic term in a coordinated fashion concurrent with didactic courses." This terminology was approved after the current study was completed, and is consistent with the operational definition used in the study. The purpose of this study was to examine whether the inclusion of ICEs in PT education curricula helped students develop their interpersonal communication skills prior to entering into their first full-time clinical experience. It was hypothesized that students who participated in an ICE would (1) perceive themselves as more confident to interact with patients as measured by the Interpersonal Communication Questionnaire (ICQ),1 and (2) perform better than students without an ICE, with regards to interpersonal skills during first, full-time clinical internships, as measured by the Medical Communication Behavior System (MCBS).2,8REVIEW OF LITERATURELearning DomainsProfessional physical therapist education consists of 3 major learning domains: cognitive (thinking or knowledge), psychomotor (hands-on skills), and affective (feelings or attitudes).9'10 The skills learned in these domains are essential for practicing PTs who are providing services to patients or clients. Following completion of an initial patient examination, PTs must identify what the patients problems are, the hands-on skills necessary for treatment, and how to interact with the patient to ensure the best outcomes. Interpersonal communication skills are essential professional behaviors expected of the physical therapist.As physical therapist students develop skills in the 3 learning domains, they are evaluated using a variety of assessments. In the academic setting, cognitive and psychomotor skills are traditionally tested using pencil and paper tests, computer-based tests, and practical examinations.11 However, affective skills, such as interpersonal communication and professionalism, are more difficult to formally assess.11 While practical examinations do measure cognitive, psychomotor, and affective skills, these examinations are most frequently conducted in an artificial environment, with classmates or instructors assuming the role of patient and/or caregiver. Familiarity with the person playing the role of the patient may provide a level of comfort during interactions, whereas communicating with and relating to a real patient-with whom students have no previous relationship-may be more difficult.1 Some physical therapist education programs have begun to include simulated patients in curricula to improve communication confidence.1'12"15 Simulated patients are professional actors who have been trained to display signs and symptoms of patients with various medical conditions and personalities.1'16'17 However, use of simulated patients can be cost-prohibitive and inadequate for building affective skills, as students are still in a familiar setting during patient interactions.13 Although using simulated patients has been validated in the literature, health care programs must consider both the fiscal impacts and time investments required to implement this pedagogical method.1'14'16'17Clinical Education Learning and AssessmentIn contrast to practical examinations, fulltime clinical internships require students to balance their cognitive, psychomotor, and affective skills while working with patients and being assessed by clinical instructors (CIs). …

Background and Purpose.Integrating skills learned in the classroom into the clinical setting can be challenging. An integrated clinical experience (ICE) is an active-learning method allowing early interactions between physical therapist students and patients/clients. The purpose of this paper is to

Background and Purpose. The move to a doctorate in physical therapy education has led to changes in the expectations for entry-level student performance. Members of the Iowa Clinical Education Consortium were interested in how clinical educators in their region would respond to this change in expectations. The purpose of this study was to explore the range of opinions among clinical educators regarding the educational implications of an enhanced definition of entry-level physical therapist performance. Participants. Thirty-four clinicians from the Midwest were invited to participate in regional focus groups. Methods. Each focus group was asked the same 3 questions considering a proposed entry-level definition: what ideal clinical education would look like; what obstacles would need to be overcome; and what support would be needed to achieve ideal clinical education based on the definition. Results. A multi-step process of thematic analysis was used to determine the core themes identified by the participants. These themes related to various academic and administrative issues that need to be addressed to implement the proposed definition in the clinical setting. These issues were diverse in nature and varied across and within practice settings. Discussion and Conclusion. This research contributes to the literature by identifying key concepts and concerns of clinical instructors in relation to implementation of the proposed definition of entry-level performance. This research provides a foundation for further exploration of this issue in terms of clinical educators' expectations of what would be necessary to implement the new definition and the potential impact on their current practices. Key Words: Clinical education, Entry-level education, Qualitative research. BACKGROUND AND PURPOSE Entry-level education in physical therapy has changed markedly in the past 20 years, not only in numbers of education programs and degrees awarded, but in curricular content. Eighty- six percent of the accredited physical therapy programs awarded a doctorate level degree in 2007, as compared to only 9.4% in 2000, and zero in 1987.1 Clinical education, or learning in the context of patient care, has always been a significant component in all physical therapist professional education programs, and now accounts for an average of 31.3% of the time spent in a physical therapist programs professional curriculum. The average total length of full-time clinical education has increased from 29.2 weeks in 2001 to 33.6 weeks in 2007. However, there is wide variation in total length of clinical education between programs, with a range of 20 to 55 weeks.1 As the clinical education portion of the curriculum has expanded, more has been asked of the facilities providing clinical education and their clinical instructors (CIs). Coupled with the increased length of clinical education experiences is the expectation that graduates will enter the profession with a higher level of competency, requiring less guidance or supervision when addressing patient problems, and demonstrating competent time-management skills.2'3 For physical therapist education programs to be accredited by the Commission on Accreditation of Physical Therapist Education (CAPTE), they must meet stringent evaluative criteria. The criteria state that schools must document that their clinical education experiences encompass: (a) management of patients/clients representative of those commonly seen in practice across the lifespan and the continuum of care, (b) practice in settings representative of those in which physical therapy is commonly practiced, (c) interaction with physical therapist role models whose practice is consistent with the program's philosophy of practice, (d) opportunities for involvement in interdisciplinary care; and (e) other experiences that lead to the achievement of expected student outcomes.4 The first goal of the Education Strategic Plan from the American Physical Therapy Association (APTA) emphasizes the importance that the profession has placed on quality clinical education. …

Background and Purpose. Collaborative health care is a process in which multiple medical providers manage the care of a patient jointly. Collaborative health care has developed as a way to achieve quality patient-centered care. Evolution of health care delivery systems has lead to interprofessional care that requires analysis and understanding of each health disciplines' model of care in order to determine common and discrete clinical strategies. The purpose of this article is to identify opportunities for collaboration between physical therapist and physician assistant practice through linkage of excellence, professional duty, and social responsibility in their professional core values, educational approach, and specialized practice issues. Methods and Materials. Information was drawn from published materials in the physical therapy, physician assistant, and health care literature, as well as the professional organizations in or related to physical therapist and physician assistant professions. Summary of Literature. Comprehensive reviews of physical therapist and physician assistant practice were conducted. Analyses of each profession and editorials on the evolution of the practice patterns for each profession have been published through out the 20th century and most recently in the early part of the 21st century. The literature has evolved as the focus of health care has shifted to address the best needs of the patient. Conclusion. This article links the professional core values and specialized practice issues of physical therapists and physician assistants. The article provides discussion of interprofessional education and collaborative patient-centered care by physical therapists and physician assistants. Key Words: Core values, Health care delivery systems, Interdisciplinary care, Interprofessional collaboration, Professionalism. INTRODUCTION Health Care Delivery Systems Collaborative health care is a process in which multiple medical providers manage the care of a patient jointly. Collaborative health care has developed as a model for quality patient-centered care. The model of collaboration and teamwork in health care has been in existence throughout the 20th century as it is well-defined in the literature.14 The main concepts for collaboration were outlined by D'Amour et al1 in their comprehensive literature review of interprofessional collaboration. The authors identified the 5 underlying health care concepts of collaboration prevailing in the literature: sharing, partnership, power, interdependency, and process. Utilizing these health care concepts, interprofessional collaboration is reaching new levels of popularity in the 21st century.4 The transformation of health care models from care for illness to wellness and prevention has renewed interest in cost-controlled, yet comprehensive, patient care. Due to escalating health care costs, delivery systems have evolved from traditional care to managed-care models. Traditional fee-for-service models focused on treating patients after onset of illness. Comprehensive managed-care models emphasize the importance of keeping people healthy, while promoting screening for early treatment of health problems, and containing costs by maximizing provider efficiency and preventing illness.5 The evolution from traditional care to comprehensive managed-care models has led to the treatment of patients by multiple providers with a range of training and philosophical approaches.4 Two such members of the health care team are physical therapists and physician assistants. Both health care professionals have distinct, yet integral, roles in patient care. The purpose of this article is to identify opportunities for collaboration between the physical therapist (PT) and physician assistant (PA) practices through practical linkage of excellence, professional duty, and social responsibility in their core values, educational approach, and professional practice issues. …

Background and Purpose. Generational differences in the classroom and workplace have been the topic of several recent books and seminars, and has inspired our hypothesis that physical therapists (PTs) from different generations may perceive professional behaviors differently. The purpose of this study was to investigate how the 2 largest generations employed in the current physical therapy workforce - the Baby Boomers Generation (born 1946-1964) and Generation X (born 1965-1981) - rank order the importance of the generic abilities. Subjects. A convenience sample of 400 PTs was systematically selected from the 2003 APTA state membership lists of Illinois, Iowa, and Wisconsin. Methods. Subjects were sent a survey-asking them to rank order the 10 generic abilities by perceived importance. Differences between rank order of the groups were analyzed using a Wilcoxon-Mann-Whitney test. Results. A total of 172 surveys were analyzed: 66 (38%) taken from Baby Boomers, and 106 (62%) taken from Generation X, which was proportional to APTA membership. Statistically significant differences (P Discussion and Conclusion. These findings suggest there is no difference in how Baby Boomers and Generation X PTs rank generic abilities. The findings also suggest there may have been a change in the perceived importance of generic abilities as the physical therapy profession has evolved over time. Further research is needed to determine how these changes occur and how to cultivate professionalism in the workplace and clinic. Key Words: Generational differences, Generic abilities, Professionalism. INTRODUCTION For the first time in history, we have 4 distinct generations in the workforce. In 1900, life expectancy was 48 years; today the average life expectancy in the United States is almost 80 years.1 The 4 distinct generations are: the Traditionalist Generation, born 1900-1945; the Baby Boomer Generation, born 1946-1964; Generation X, born 1965-1981; and the Millennial Generation, born 1982-2000. Each generation comes to the workplace and classroom with vastly different experiences and expectations, which may lead to misunderstanding and conflict among the staff.1-6 Lancaster and Stillman coined the term "clashpoints" to describe issues that generations view from very different perspectives,' such as time off work. Older generations are very loyal to their job, traditionally keep strict guidelines of vacation time and sick leave, and tend to stockpile sick time "just in case." On the other hand, younger generations are less hesitant to use sick days, not stockpile them, and don't believe an explanation is necessary as to whether they were really sick or just taking a "mental health" day. As unscheduled absences disrupt the workplace and create stress, pressure on companies to address these generational differences has been mounting.1 Other environments, such as the classroom, may also be subject to these different perspectives between generations and the conflict which results. The 2 largest generations represented in the American Physical Therapy Association (APTA) are the Baby Boomer and Generation X.7 These 2 groups may see the world differently because generational differences are thought to be a result of societal influences during the formative years of life3,4 (Table 1). The Baby Boomers were influenced by civil rights, sex, drugs, and rock and roll. Their general outlook on life is described as optimistic. …

Purpose: Allied health profession students must develop critical thinking and problem solving skills to be able to make clinical decisions. The purpose of this paper is to describe an educational model used in a physical therapist education program to improve students’ confidence in clinical decision-making. Methods: The faculty chose topics for each forum and invited specific clinicians to present actual clinical cases to students in small group settings. The small groups spent 30 minutes focused on each case, and then rotated to a different clinician so each had exposure to three scenarios. After presenting subjective clinical information, the clinicians asked open-ended questions designed to encourage the students to think critically and to problem solve using the Patient/Client Management Model. Assessment of Model:Preliminary assessments were completed using a survey and large group debriefing. Survey responses identified that students perceived the forums as beneficial for improving their confidence with critical thinking and problem solving skills. Students identified the forums as a strength of their educational program in debriefing sessions. Conclusion: An educational forum is a teaching method that places students in a situation where they are required to exercise their clinical reasoning skills. The authors believe this interactive educational method can be adapted to improve students’ confidence in clinical reasoning in any allied health profession education program.