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Introduction Dr Camara Jones, former president of the American Public Health Association (APHA), stated that 'racism saps the strength of our entire society through the waste of human resources.' (1) [...], Objective. This scoping review synthesizes and summarizes the evidence on racial and ethnic disparities in outcomes after physical therapist treatment. Methods. Four databases from 2001 through 2021 were searched for articles reporting physical therapy outcomes across racial and ethnic groups. The Arksey and O'Malley methodological framework was adapted for this scoping review. Two reviewers screened the abstracts, and 5 reviewers screened full texts for inclusion. Five reviewers extracted information including study design, diagnoses, setting, outcomes reported, the domains the outcomes measured, and racial and ethnic groups included. To identify disparities, summarized differences in outcomes (better, worse, no difference) for each racial and ethnic group compared to White patients were calculated. Results. Of 1511 abstracts screened, 65 met inclusion criteria, 57 of which were observational designs. All 65 articles included non-Hispanic White patients as the reference group. A majority of the physical therapy outcomes reported by race were for Black patients and/or Hispanic or Latino patients, whereas outcomes for Asian, American Indian, Alaskan Native, and/or Native Hawaiians or Pacific Islander patients were reported infrequently. Most articles reported disparities in health outcomes for patients in the inpatient rehabilitation setting (n = 48) and for adults (n = 59) with neurologic diagnoses (n = 36). Compared to White patients, worse outcomes were reported more frequently for all marginalized racial and ethnic groups after physical therapy, with the exception of marginalized groups having the same or better outcomes for successful post-rehabilitation community discharge. Conclusion. Gaps remain in understanding outcome disparities beyond older adult and neurologic populations as well as for musculoskeletal diagnoses frequently treated by physical therapists. Impact. The presence of racial and ethnic disparities in physical therapy outcomes should motivate physical therapists to understand the mechanisms underlying disparities and focus on social and structural drivers of health inequity in their clinical decision-making. Keywords: Bias (Epidemiology), Decision Making, Effect Modifiers (Epidemiology), Epidemiologic Factors, Patient Care, Public Health, Rehabilitation, Search Strategies, Social Responsibility

Introduction Low back pain (LBP) is a large burden for individual sufferers and societies around the world. (1-3) Regardless of age, gender, occupation, socioeconomic indicators, and various comor-bidities, LBP is [...], Objective. The objective of this study was to examine the associations between active, passive, and manual therapy interventions with the escalation-of-care events following physical therapist care for veterans with low back pain (LBP). Methods. A retrospective cohort study was conducted in 3618 veterans who received physical therapist care for LBP between January 1, 2015 and January 1, 2018. The Department of Veterans Affairs (VA) Corporate Data Warehouse was utilized to identify LBP-related physical therapist visits and procedures, as well as opioid prescription and non-physical therapy clinic encounters. The association between physical therapist interventions with 1-year escalation-of-care events were assessed using adjusted odds ratios from logistic regression. Results. Nearly all veterans (98%) received active interventions, but only a minority (31%) received manual therapy. In the 1-year follow-up period, the odds of receiving an opioid prescription were 30% lower for those who received manual therapy in addition to active interventions, as compared with patients who received only active interventions. Moreover, the odds of receiving primary care, specialty care, and diagnostic testing were 30% to 130% higher for patients who received electrical stimulation or more than 1 passive intervention in addition to active treatments, as compared with patients who received only active interventions. Conclusion. The use of manual therapy along with active interventions was associated with reduced prescription of opioids, while utilization of specific passive interventions such as electrical stimulation or multiple modalities in conjunction with active interventions resulted in increased escalation-of-care events. Impact. The use of active interventions, which is supported by most clinical practice guidelines, was the cornerstone of physical therapist care for veterans with LBP. However, the use of clinical practice guideline-recommended manual therapy interventions was low but associated with reduced opioid prescriptions. The use of 2 or more different passive interventions along with active interventions was common (34%) and associated with less-than-optimal escalation-of-care outcomes. Keywords: Exercise Therapy, Guideline Adherence, Low Back Pain, Manual Therapy, Veterans

Introduction With an increased visibility of people who identify as transgender, gender diverse, and nonbinary (TGNB) in Australia and New Zealand, (1,2) the need for TGNB-specific health care is rising. [...], Objective. The objective was to explore experiences with and identify barriers and facilitators of utilizing physical therapy for people who identify as transgender, gender diverse, and nonbinary (TGNB). Methods. A qualitative descriptive design was employed using semistructured interviews conducted in New Zealand. Eligible participants were individuals who were 12 years old or older, who self-identified as TGNB, and who had accessed physical therapy at a community-based clinic that also provides a gender-affirming service. Participants were recruited via email invitation to the clinic database. Interview data were analyzed using reflexive thematic analysis. Demographics are reported descriptively. Results. Seventeen individuals (15-64 years old and identifying as 11 different genders) participated. All participants reported physical therapy experiences relating to 1 or more of the following 4 themes: challenging cisnormativity at policy, environmental, clinic, and therapist levels; safety and trust throughout the clinical experience, including clinic credibility for being a safe provider, clinic displays of TGNB inclusivity, implementation of safe clinic processes, and respectful therapist interactions; inclusive experiences in a clinic that provided affordable care and took active steps to understand and affirm TGNB identities and with physical therapists who had a high level of knowledge of TGNB-specific health issues and took a biopsychosocial approach to care; and sensitivity to body discomfort or dysphoria triggers. Barriers to and facilitators of care were identified at policy, environmental, clinic, and therapist levels. Conclusion. People who identify as TGNB face challenges to accessing safe and culturally sensitive physical therapy. However, there are achievable areas for improvement at policy, environmental, clinic, and physical therapist levels to gain trust and engagement in care for the TGNB community. Impact. This study provides a detailed exploration of TGNB physical therapy experiences and identifies specific areas of improvement for TGNB physical therapy care to provide clinicians and physical therapy clinics insights into the provision of safe and culturally sensitive physical therapy. Keywords: Gender and Sexual Minorities, Gender Identity, Health, Physical Therapy, Transgender

Introduction Globally, older adults are the fastest-growing segment of the population, and it is expected that 1 in 6 people will be aged 60 years or older by 2030. (1,2) [...], Objective. The aim of this study was to systematically review physical therapists' and physical therapist students' attitudes toward working with older adults. Methods. CINAHL, EMBASE, ERIC, MEDLINE, Scopus, PsycINFO, and SocIndex databases were searched in duplicate (from inception to March 2023). Studies that assessed knowledge on aging, intention to work with older adults or attitudes toward older adults for physical therapist students and/or clinicians, and that were written in English, Finnish, Spanish, or Swedish were included. Grey literature, qualitative studies, or articles of people with a specific diagnosis (eg, dementia) were excluded. All articles were reviewed by 2 authors independently, and consensus was required for inclusion. Data extraction was completed using a standardized data extraction sheet. Results. Of 2755 articles screened, 34 met the inclusion criteria. Twenty-five studies recruited only physical therapist students, 6 recruited only physical therapist clinicians, and 3 involved mixed samples of both. Ten intervention studies were included, all of which recruited physical therapist students. Overall, physical therapist students were observed to have predominantly positive attitudes toward older adults, while clinicians had neutral to weak positive attitudes toward older adults. Both physical therapist students and clinicians were observed to have low knowledge on aging and low intentions to work with older adults. Results from intervention studies suggest that education combined with clinical experience with older adults improves attitudes toward older adults. Conclusion. A discrepancy is observed in physical therapists in that although attitudes toward older adults are positive, a lack of knowledge on aging and a disinterest in working with older adults exists. Intervention studies suggest that clinical experience may improve attitudes toward older adults in physical therapist students. Impact. Predominantly positive attitudes toward older adults are reported by physical therapist students, while for clinicians mixed results are observed. Education coupled with clinical experiences appears to be effective interventions to improve attitudes toward older adults, but such research has only been explored in student samples. Keywords: Aged, Attitude, Knowledge, Perception, Physical Therapist Specialty

Introduction Physical therapist care has traditionally been delivered through face-to-face consultations. However, for many people, access to physical therapy is limited by geographic isolation, limited local services, or difficulty in [...], Objectives. The aim of this study was to determine the concurrent validity and reliability of the Osteoarthritis Research Society International recommended performance-based tests delivered by video-based in adults with knee osteoarthritis. Methods. Thirty-two participants (aged 40-70 years; 15 men) undertook assessments of 4 performance-based tests via both video-based (real-time and recorded) and face-to-face approaches, on the same day. Outcome measures were performance-based test and the number of technical issues encountered. The performance-based tests included the 40-Meter Fast-Paced Walk Test (velocity, m/s), the 30-Second Chair Stand Test (number of repetitions), the Stair Climb Test (time, seconds), and the Timed "Up & Go" Test (time, seconds). The Bland-Altman limit of agreement measures, standard error of measurement (SEM), coefficient of variation (CV), minimal detectable changes, and bias (mean difference) were employed to analyze the concurrent validity between video-based and face-to-face approaches of the performance-based tests. Reliability was measured using intraclass correlation coefficients, CV, and SEM. Results. A high degree of concurrent validity for the Timed "Up & Go" Test (bias =-0.22), the 30-Second Chair Stand Test (bias =-0.22), the Stair Climb Test (bias = -0.31), and the 40-Meter Fast-Paced Walk Test (bias =-0.06) was found. SEM and CV values were within the acceptable level for concurrent validity. There was a high degree of reliability demonstrated for all tests analyzed. Intraclass correlation coefficient measures ranged from 0.95 to 1.00 for intrarater reliability, and from 0.95 to 0.99 for interrater reliability. Conclusions. Video-based assessment of physical performance tests is a valid and reliable tool for measuring physical function among adults with knee osteoarthritis via Microsoft Teams (Microsoft Corp, Redmond, WA, USA). Impact. Video-based assessment is a promising public health tool to measure physical function in adults with knee osteoarthritis. Keywords: Digital Technology, Knee Osteoarthritis, Video-Based Assessment, Virtual Rehabilitation

Orthopaedic Manual Physical Therapy Orthopaedic manual physical therapy (OMPT) is a subspecialty of the profession of physical therapy. (1) Some fundamental OMPT skills and competencies are taught in professional programs, [...], Currently, orthopaedic manual physical therapy (OMPT) lacks a description of practice that reflects contemporary thinking and embraces advances across the scientific, clinical, and educational arms of the profession. The absence of a clear definition of OMPT reduces understanding of the approach across health care professions and potentially limits OMPT from inclusion in scientific reviews and clinical practice guidelines. For example, it is often incorrectly classified as passive care or incorrectly contrasted with exercise-therapy approaches. This perspective aims to provide clinicians, researchers, and stakeholders a modern definition of OMPT that improves the understanding of this approach both inside and outside the physical therapist profession. The authors also aim to outline the unique and essential aspects of advanced OMPT training with the corresponding examination and treatment competencies. This definition of practice and illustration of its defining characteristics is necessary to improve the understanding of this approach and to help classify it correctly for study in the scientific literature. This perspective provides a current definition and conceptual model of OMPT, defining the distinguishing characteristics and key elements of this systematic and active patient-centered approach to improve understanding and help classify it correctly for study in the scientific literature. Keywords: Definition, Manual Therapy, OMPT, Practice

Introduction Congenital Muscular Torticollis Congenital muscular torticollis (CMT) may present as a postural preference or involve unilateral sternocleidomastoid (SCM) muscle tightness, shortening, or fibrosis, resulting, in most cases, in cervical [...], Objective. The purposes of this pilot study were to compare short-term outcomes of the Perception-Action Approach (P-AA) and standard care based on 5 components of first-choice interventions listed in the congenital muscular torticollis (CMT) clinical practice guideline. Changes in postural alignment, symmetrical use of both sides of the body during movement and play, gross motor development, and behavior observed during therapy were considered. Methods. Thirty-two participants were enrolled in a 2-group (P-AA and standard care) randomized, single-blind trial with pre--posttest measures. Participants were infants with CMT, age range 5 to 35 weeks at enrollment. Outcome measures administered at initial and final evaluations included still photography, arthrodial goniometry, Muscle Function Scale, Alberta Infant Motor Scale, and Functional Symmetry Observation Scale. Participants in both groups attended 3 intervention sessions. Their behavior exhibited during therapy was compared using the Therapy Behavior Scale Version 2.2. Results. Data collection was interrupted by the COVID-19 pandemic lockdown. Twenty-four infants completed the study (10 in P-AA and 14 in the standard care group). There were no significant differences between the groups in performance at initial and final evaluations. Both groups improved on most outcome measures. The P-AA group made greater gains on the Functional Symmetry Observation Scale, and the Therapy Behavior Scale Version 2.2 scores were higher in the P-AA group; however, these results did not reach significance. Conclusion. Results suggest that similar short-term outcomes may be obtained in infants with CMT undergoing P-AA and standard care interventions. Definitive conclusions regarding the efficacy of the P-AA in infants with CMT cannot be made at this time. Nevertheless, the pilot findings provide valuable preliminary data for a future efficacy trial, which will require funding. Impact. This was the first randomized controlled trial to provide evidence for use of P-AA intervention in infants with CMT. Lay Summary. Compared to standard treatment, the Perception-Action Approach (P-AA) provided similar short-term benefits to infants with congenital muscular torticollis. The P-AA group participants demonstrated higher symmetry and behavior scores, which needs to be confirmed in a larger future study. Keywords: Infant, Muscular, Perception-Action, Passive Stretching

Introduction The health care of marginalized communities has been at the forefront of diversity, equity, and inclusion initiatives across the USA. Among the marginalized is the health and health care [...], Objective. The purpose of this study was to understand the lesbian, gay, bisexual, transgender, queer, intersex, agender, and other gender and sexually diverse identities (LGBTQIA+) health care experience and associated cultural competence from the physical therapist perspective (physical therapist and physical therapist assistant). Methods.An exploratory qualitative approach implementing semi-structured focus groups and private interviews was utilized. To further anonymity, researchers allowed subjects to keep their camera off on Zoom. An interview protocol included questions guided by Campinha-Bacote domains of cultural competence (cultural awareness, skill, knowledge, encounter, and desire) to collect individual experiences, stories, discussions, thoughts, and opinions. Physical therapist clinicians were recruited from the clinical education affiliation lists of Regis University and Thomas Jefferson University. Seventy-one practicing physical therapists from the USA agreed to be part of the study. Results. Themes were organized using the Social Ecological Model Framework. Themes are in parentheses following each level of the Social Ecological Model and include intrapersonal level (psychological stress and implicit and explicit biases), interpersonal (acceptance and competency), organizational (experience), community (advocacy), and society and policy (explicit biases and policy). Conclusion. Cultural competence in physical therapy is influenced by intrapersonal, interpersonal, organizational, community, and social and policy factors. Themes of psychological stress, limited awareness, decreased acceptance, and competency as well as limited exposure and experience, and a lack of advocacy and broader societal and policy issues prevent adequate LGBTQIA+ cultural competency of physical therapist providers. Further research in the physical therapist profession is needed to elaborate on the student, educator, and patient perspectives and how this information informs the LGBTQIA+ cultural competence of clinicians. Impact. This project may have a significant impact on suggestions for the delivery of content for health profession education to best impact health equity goals and save lives. Implementation of this content may have a direct impact on health disparities in LGBTQIA+ populations by reducing stigma and discrimination from health care providers, thus improving quality of health care and decreasing rates of patient mortality for LGBTQIA+ individuals. Keywords: Cultural Competence, Diversity, LGBTQ, Physical Therapy, Policy

Introduction Manual therapy is a commonly recommended intervention in clinical practice guidelines for a variety of musculoskeletal conditions including low back pain (LBP). (1-14) Reported benefits include improved blood flow [...], Objective. The purpose of this scoping review was to evaluate and characterize the scope of care for low back pain that falls under the specific label of manual therapy. Methods. PubMed database, Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and SPORTDiscus were searched from journal inception through May 2022 for randomized controlled trials that investigated the treatment of low back pain using manual therapy. Terminology used to define manual therapy was extracted and categorized by using only the words included in the description of the intervention. An expert consultation phase was undertaken to gather feedback. Results. One hundred seventy-six trials met final inclusion criteria, and 169 unique terms labeled as manual therapy for the treatment of low back pain were found. The most frequent terms were mobilization (29.0%), manipulation (16.0%), and thrust (6.4%). Eight percent of trials did not define or specify what type of manual therapy was used in the study. After removing duplicates, 169 unique terms emerged within 18 categories. Conclusions. Manual therapy intervention labels used in low back pain trials are highly variable. With such variation, the heterogeneity of the intervention in trials is likely large, and the likelihood that different trials are comparing the same interventions is low. Researchers should consider being more judicious with the use of the term manual therapy and provide greater detail in titles, methods, and supplementary appendices in order to improve clarity, clinical applicability, and usefulness of future research. Impact. The ability to interpret and apply findings from manual therapy--related research for low back pain is challenging due to the heterogeneity of interventions under this umbrella term. A clear use of terminology and description of interventions by researchers will allow for improved understanding for the role of manual therapy in managing back pain. Keywords: Back Pain, Low Back Pain, Manipulation: Orthopedic, Manipulation: Spinal, Musculoskeletal Manipulations, Orthopedics, Physical Therapists, Spinal Manipulation

Background and Purpose Prostate cancer is a significant health concern in the USA, with approximately 280,000 new cases and 35,000 deaths in 2022. (1) Radical prostatectomy (RP) is the primary [...], Objective. Prostate cancer is the most commonly diagnosed cancer among men in the USA, and radical prostatectomy (RP) is the primary surgical treatment option. With an increasing number of men undergoing RP and surviving prostate cancer, clinical management strategies have broadened to improve the preoperative and postoperative patient experience and minimize treatment-related functional consequences. Urinary incontinence is a predictable functional consequence of RP. Recent reviews recommend preoperative and postoperative physical therapist services as the standard of care for men undergoing RP to decrease the severity of urinary incontinence and improve patients' quality of life. Despite compelling evidence, the routine provision of physical therapist services preoperatively and postoperatively for men undergoing RP is limited. The purpose of this case report is to describe the implementation of preoperative and postoperative physical therapist services for men undergoing RP in a US health care system using the knowledge-to-action process and the Consolidated Framework for Implementation Research frameworks. Case Description. The implementation process included 4 steps: (1) development of a preoperative and postoperative physical therapist services program; (2) identification of barriers and enablers for implementation; (3) implementation of the program; and (4) evaluation of the effectiveness of the implemented program. Results. Outcomes from the implementation of a physical therapist services program for men undergoing RP included lower urinary incontinence rates, improved patient satisfaction, and increased physical therapist utilization. Conclusion. This case report documents the implementation of physical therapist services for men undergoing RP. The use of implementation frameworks enabled the identification of unique enablers, barriers, and strategies for the implementation of physical therapist services for men undergoing RP. Impact. Implementing preoperative and postoperative physical therapist services for men undergoing RP improves patient outcomes. The implementation process and outcomes can be considered by other health care systems when developing preoperative and postoperative physical therapist services for men undergoing RP. Keywords: Health Plan Implementation, Men's Health Services, Physical Therapist Department: Hospital, Postoperative Care, Preoperative Care, Prostatectomy

Introduction During the early phases of the coronavirus disease-2019 (COVID-19) pandemic, state and federal policies were modified, allowing many physical therapists in the United States to begin providing care through [...], Objective. The coronavirus disease-2019 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the relationship between individual patient factors and substantial clinical benefit from telerehabilitation among a cohort of patients with chronic low back pain (LBP). Methods. This is a secondary analysis of data collected during a prospective longitudinal cohort study. Patients with chronic LBP (N = 98) were provided with a standardized physical therapy protocol adapted for telerehabilitation. We examined the relationship between patient factors and substantial clinical benefit with telerehabilitation, defined as a [greater than or equal to]50% improvement in disability at 10 weeks, measured using the Oswestry Disability Index. Results. Sixteen (16.3%) patients reported a substantial clinical benefit from telerehabilitation. Patients reporting substantial clinical benefit from telerehabilitation had lower initial pain intensity, lower psychosocial risk per the STarT Back Screening Tool, higher levels of pain self-efficacy, and reported higher therapeutic alliance with their physical therapist compared to other patients. Conclusion. Patients with lower psychosocial risk and higher pain-self efficacy experienced substantial clinical benefit from telerehabilitation for chronic LBP more often than other patients in our cohort. Therapeutic alliance was higher among patients who experienced a substantial clinical benefit compared to those who did not. Impact. This study indicates that psychosocial factors play an important role in the outcomes of patients receiving telerehabilitation for chronic LBP. Baseline psychosocial screening may serve as a method for identifying patients likely to benefit from this approach. Keywords: Patient-Centered Care, Precision Medicine, Risk Factors, Telemedicine

Introduction Integrative health is an evidence-based healing-oriented approach that takes into account the whole person, emphasizes lifestyle and the therapeutic relationship between practitioner and patient, and makes use of all [...], Integrative health is an emerging specialty inside multiple disciplines within the medical community, yet the practice of integrative physical therapy remains undefined. This perspective paper suggests a set of guiding principles to support the role of physical therapy in integrative health. These guiding principles, including therapeutic partnership, whole person health, living systems, movement as an integrative experience, and salutogenesis, are described and explored in-depth as they relate to all aspects of patient care and clinician experience. These guiding principles are articulated within the context of social determinants of health and the interrelated roles that environment, trauma, stress, and lifestyle all play within an integrative physical therapy plan of care. Examples of current integrative physical therapy practices that embody these principles are described. The 5 guiding principles are designed to elicit interprofessional inquiry into how integrative health models can be applied to the art and science of physical therapy practice. The expansion of integrative health into the field of physical therapy has the potential to improve individual and population health, as integrative physical therapy can be used to address prevention, health promotion, primary care, and wellness while acknowledging the complex, dynamic, and interconnected nature of the human condition. Impact. This perspective article presents 5 guiding principles to establish a framework to define and shape the growing application of an integrative health model to physical therapy practice. These integrative physical therapy guiding principles aim to improve the quality of whole-person, patient-centered care. Keywords: Integrative Health, Integrative Medicine, Physical Therapy, Integrative Physical Therapy, Integrative Physiotherapy, Whole Person, Whole Person Health, Whole Person Care, Whole Person Physical Therapy, Trauma-Informed Care, Complementary Therapies, Mind Body Medicine

Introduction Fragmented referral pathways are often traveled with inconvenience and frustration by patient and provider alike. (1) When primary care providers refer to specialists, there are often low appointment scheduling [...], Efficient referral pathways have held promise in improving clinical outcomes, raising patient satisfaction, and reducing costs. Referral decision-making presents a distinct challenge because it requires the consideration of such variables as technology, health-care systems, and local resources. However, best practices for generating a high-value referral and improving care continuity are rarely discussed in the context of physical therapist practice. With physical therapists in some states obtaining explicit imaging privileges and a renewed focus on the physical therapist's role in primary care and patient management over the lifespan, it is time to focus on this underappreciated area of practice. This perspective discusses referral decision-making and provides recommendations for making a high-value referral and improving care continuity. Improving referral and care continuity has potential to enhance clinical outcomes and patient satisfaction and to reduce costs. This perspective explicitly defines and describes strategies to improve physical therapist decision-making about referral and care continuity to improve overall patient management. Keywords: Continuity of Patient Care, Decision-Making: Clinical, Primary Health Care, Referral and Consultation

Introduction Stroke remains a leading cause of adult disability. (1,2) More than 50% of patients with a stroke have limitations in activities of daily living, and up to 40% use [...], Objective. This study investigated the validity, reliability, responsiveness, and interpretability of the Patient-Specific Functional Scale (PSFS) in subacute stroke rehabilitation to determine its suitability to measure patient-identified rehabilitation goals. Methods. A prospective observational study was designed according to the checklist from Consensus-Based Standards for Selecting Health Measurement Instruments. Seventy-one patients diagnosed with stroke were recruited in the subacute phase from a rehabilitation unit in Norway. The International Classification of Functioning, Disability and Health was used to assess the content validity. Assessment of construct validity was based on hypotheses for correlation of the PSFS and comparator measurements. We assessed reliability by calculating the Intraclass Correlation Coefficient (ICC) (3.1) and the standard error of measurement. The assessment of responsiveness was based on hypotheses for the correlation of change scores between the PSFS and the comparator measurements. A receiver operating characteristic analysis was conducted to assess responsiveness. The smallest detectable change and minimal important change were calculated. Results. Eighty percent of the PSFS items were classified as activities and participation in the International Classification of Functioning, Disability and Health, indicating satisfactory content validity. The reliability was satisfactory with an ICC of 0.81 (95% CI = 0.69-0.89). The standard error of measurement was 0.70 point, and the smallest detectable change was 1.94 points. Five of 7 hypotheses were confirmed for construct validity, and 5 of 6 were confirmed for responsiveness, indicating moderate construct validity and high responsiveness. Assessing responsiveness with a criterion approach resulted in an area under the curve of 0.74. A ceiling effect was identified for 25% of the participants 3 months after discharge. The minimal important change was estimated to be 1.58 points. Conclusion. This study demonstrates satisfactory measurement properties for the PSFS in individuals undergoing inpatient stroke rehabilitation. Impact. This study supports the use of the PSFS to document and monitor patient-identified rehabilitation goals in patients receiving subacute stroke rehabilitation when applied using a shared decision approach. Keywords: Goals, Patient-Reported Outcome Measure, Patient-Specific Functional Scale, Rehabilitation, Shared Decision Making, Stroke

Introduction Affecting 1.71 billion people worldwide in 2019, musculoskeletal (MSK) conditions are the most prevalent type of condition requiring rehabilitation. (1) Evidence from meta-analyses on MSK conditions reveals that most [...], Objective. The purpose of this systematic review was to identify and appraise externally validated prognostic models to predict a patient's health outcomes relevant to physical rehabilitation of musculoskeletal (MSK) conditions. Methods. We systematically reviewed 8 databases and reported our findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. An information specialist designed a search strategy to identify externally validated prognostic models for MSK conditions. Paired reviewers independently screened the title, abstract, and full text and conducted data extraction. We extracted characteristics of included studies (eg, country and study design), prognostic models (eg, performance measures and type of model) and predicted clinical outcomes (eg, pain and disability). We assessed the risk of bias and concerns of applicability using the prediction model risk of bias assessment tool. We proposed and used a 5-step method to determine which prognostic models were clinically valuable. Results. We found 4896 citations, read 300 full-text articles, and included 46 papers (37 distinct models). Prognostic models were externally validated for the spine, upper limb, lower limb conditions, and MSK trauma, injuries, and pain. All studies presented a high risk of bias. Half of the models showed low concerns for applicability. Reporting of calibration and discrimination performance measures was often lacking. We found 6 externally validated models with adequate measures, which could be deemed clinically valuable [ie, (1) STart Back Screening Tool, (2) Wallis Occupational Rehabilitation RisK model, (3) Da Silva model, (4) PICKUP model, (5) Schellingerhout rule, and (6) Keene model]. Despite having a high risk of bias, which is mostly explained by the very conservative properties of the PROBAST tool, the 6 models remain clinically relevant. Conclusion. We found 6 externally validated prognostic models developed to predict patients' health outcomes that were clinically relevant to the physical rehabilitation of MSK conditions. Impact. Our results provide clinicians with externally validated prognostic models to help them better predict patients' clinical outcomes and facilitate personalized treatment plans. Incorporating clinically valuable prognostic models could inherently improve the value of care provided by physical therapists. Keywords: Musculoskeletal Pain, Pain, Physical Therapy Modalities, Prognosis, Rehabilitation

Introduction Stroke is known as a disabling condition. (1) The number of people living with stroke is estimated to increase by 27% between 2017 and 2047, mainly because of the [...], Objective. The purpose of this study was to examine the evidence of the efficacy of rehabilitation approaches for improving severe upper limb impairments and disability during acute and early subacute stroke, taking into consideration the dosage of therapy. Methods. Randomized controlled trials from PubMed, Web of Science, and Scopus databases were searched by 2 independent researchers. Studies were selected if they involved active rehabilitation interventions that were conducted in the acute stage (7 days-3 months after stroke), with the aim of improving severe upper limb motor impairments and disability. Data were extracted on the basis of the type and effect of rehabilitation interventions and on the dosage (duration, frequency, session length, episode difficulty, and intensity). Study quality was assessed using the Physiotherapy Evidence Database Scale. Results. Twenty-three studies (1271 participants) with fair to good methodological quality were included. Only 3 studies were performed in the acute stage. Regardless of the type of intervention, upper limb rehabilitation was found to be beneficial for severe upper limb impairments and disability. Robotic therapy and functional electrical stimulation were identified as the most popular upper limb interventions; however, only a limited number of studies showed their superiority over a dose-matched control intervention for severe upper limb impairments in the subacute stage. A longer rehabilitation session length ( Conclusion. Different rehabilitation approaches seem to improve severe upper limb impairments and disability in the subacute stage after stroke; however, they are not distinctly superior to standard care or other interventions provided at the same dosage. Impact. Robotic therapy and functional electrical stimulation add variety to rehabilitation programs, but their benefit has not been shown to exceed that of standard care. Further research is necessary to identify the impact of dosage parameters (eg, intensity) on severe upper limb motor impairments and function, especially in the acute stage. Keywords: Arm and Hand, Cerebrovascular Accident, Dosage, Motor Recovery, Neurological Rehabilitation, Technology

Introduction Stroke is a leading cause of long-term disability in the United States, and its prevalence is projected to increase by 20% over the next decade, along with a 150% [...], Objective. The purpose of this study was to determine the factors influencing the discharge to an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF) of people poststroke with Medicare Advantage plans. Methods. A retrospective cohort study was conducted with data from naviHealth, a company that manages postacute care discharge placement on behalf of Medicare Advantage organizations. The dependent variable was discharge destination (IRF or SNF). Variables included age, sex, prior living setting, functional status (Activity Measure for Post-Acute Care [AM-PAC]), acute hospital length of stay, comorbidities, and payers (health plans). Analysis estimated relative risk (RR) of discharge to SNF, while controlling for regional variation. Results. Individuals discharged to an SNF were older (RR = 1.17), women (RR = 1.05), lived at home alone or in assisted living (RR = 1.13 and 1.39, respectively), had comorbidities impacting their function "some" or "severely" (RR = 1.43 and 1.81, respectively), and had a length of stay greater than 5 days (RR = 1.16). Individuals with better AM-PAC Basic Mobility (RR = 0.95) went to an IRF, and individuals with better Daily Activity (RR = 1.01) scores went to an SNF. There was a substantial, significant variation in discharge of individuals to SNF by payer group (RR range = 1.12-1.92). Conclusions. The results of this study show that individuals poststroke are more likely to be discharged to an SNF than to an IRF. This study did not find a different discharge decision-making picture for those with Medicare Advantage plans than previously described for other insurance programs. Impact. Medicare Advantage payers have varied patterns in discharge placement to an IRF or SNF for patients poststroke. Keywords: Medicare, Rehabilitation, Stroke

Introduction Spinal manual or manipulative therapy (SMT) is a commonly used intervention to treat patients with spinal conditions. It is one of the preferred methods of both therapists and patients. [...], Objective. Spinal manual therapy (SMT) is often used to treat patients with spinal disorders; however, the underlying mechanisms of SMT are not fully understood. This systematic review and meta-analysis investigates the effect of SMT compared with sham treatment or no intervention on local or remote (segmental or non-segmental) pressure pain thresholds (PPTs) in patients with chronic musculoskeletal conditions and people who are pain free. Methods. A systematic search was conducted in the PubMed, Cochrane Library, Web of Science, and CINAHL databases. Randomized controlled trials investigating the effect of SMT on PPTs in patients with chronic musculoskeletal conditions and in people who were pain free were included. Quality assessment and evidence synthesis were performed according to Cochrane Handbook recommendations. A meta-analysis was performed using standardized mean difference and 95% CIs. Results. Twenty-two reports were included in the present review. There were no significant results for an immediate effect of SMT on local (low certainty of evidence), remote (segmental) (low certainty of evidence), and remote (non-segmental) (low certainty of evidence) PPTs in patients with chronic pain as well as on local (moderate certainty of evidence) and remote (segmental) (low certainty of evidence) PPTs in people who were pain free. A small but significant effect (standardized mean difference = 0.26; 95% CI = 0.01 to 0.51; low certainty of evidence) was observed on remote (non-segmental) PPTs in people who were pain free, which was not considered a meaningful effect size. Conclusion. No immediate, consistent, or meaningful hypoalgetic effect of SMT was shown on PPTs on various body areas. Involvement of spinal or supraspinal underlying mechanisms were, therefore, not confirmed via PPTs but should still be investigated using methods designed to assess central nervous pain processing. Impact. No consistent and meaningful hypoalgesic effects of spinal manual therapy were demonstrated on PPTs in participants who were pain free and in patients with chronic musculoskeletal disorders. Keywords: Manual Therapy, Spinal Manipulative Therapy, Hypoalgesia, Widespread, Pressure Pain Threshold

Objective. Provision of early rehabilitation services during acute hospitalization after a hip fracture is vital for improving patient outcomes. The purpose of this study was to examine the association between [...]

1 | INTRODUCTION Older adults account for almost 50 percent of hospitalizations in U.S. acute care hospitals, excluding maternal and neonatal hospitalizations. (1) In 2018, 13.2 million of the 27.8 [...], Objective: To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission. Data Sources: EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017-February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019-July 2021). Study Design: We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted. Data Extraction: We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay. Principal Findings: In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI -0.57, -0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission ([beta] = 0.01; 95% CI -0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI -0.88, -0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA. Conclusions: Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments. KEYWORDS functional status measurement, observational data/quasi-experiments, aging/elderly/geriatrics, health care organizations and systems, rehabilitation services What is known on this topic * The World Health Organization and The Joint Commission recommend early interdisciplinary rehabilitation, including physical therapy, in the acute care setting for patients following stroke * Patients after a stroke benefit from mobility, but hospitals experience difficulty keeping patients mobile throughout the hospital stay * Methods are needed to facilitate appropriate referral of patients to physical therapy in the acute care setting with mobility impairments What this study adds * After a stroke, patients with automated EHR-generated hospital physical therapy referrals based on mobility assessments had relatively reduced readmission or mortality rates compared to those without this referral * We found the effect of automated physical therapy referrals on readmission or mortality rates was larger in sicker patients, older adults, and older adults who returned home after a hospitalization * The relationship between acute care rehabilitation services and hospital performance metrics such as length of stay was unclear, probably because additional care comes with a cost of time

Introduction Ulnar nerve entrapment at the elbow (UNE), or the cubital tunnel syndrome, constitutes the second-most prevalent compressive neuropathy in the upper extremity after carpal tunnel syndrome. (1) People with [...], Objective. The objective of this study was to systematically review, critically appraise, and synthesize evidence on the measurement properties of patient-reported outcome measures (PROMs) for people with ulnar nerve entrapment at the elbow (UNE). Methods. CINAHL, MEDLINE, Embase, and Scopus were searched for studies reporting on the psychometric properties of the PROMs used to assess pain, disability, and quality of life of people with UNE. Relevant data were extracted based on the Consensus-Based Standards for the Selection of Health Measurement Instruments 2018 checklist. Two authors independently rated the quality and risk of bias of the studies. A qualitative synthesis was performed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. The results were categorized based on the identified PROMs, and all the psychometric properties were summarized and presented. Results. Eight included studies had a quality score of very good or higher. Among all the included PROMs, the Patient-Rated Ulnar Nerve Evaluation (PRUNE) was comprehensively evaluated in 4 studies and had high reliability, appropriate correlation to the physical component summary score of the 36-Item Short-Form Health Survey (r =-0.68), excellent content (cognitive interviews), structural (factor analysis) and discriminative validities, and high responsiveness. The Disabilities of the Arm, Shoulder and Hand Questionnaire was assessed in 5 studies and had appropriate properties, showing a high correlation with the 8-Item Short-Form Health Survey (r = 0.77) and PRUNE (r = 0.75) and moderate responsiveness. Conclusions. The PRUNE was the most specific to UNE, had the most supporting studies and evidence of excellent reliability, validity, and responsiveness and therefore was the preferred PROM. The Disabilities of the Arm, Shoulder and Hand Questionnaire demonstrated more limited validation across 5 studies and had moderate responsiveness. Information on other included PROMs was limited in terms of psychometric properties. Impact. This study provides insight into which PROM is potentially more suitable for measuring outcomes related to UNE. Keywords: Applied Measurement, Reliability, Responsiveness, Ulnar Nerve Compression Syndrome, Validity

Introduction Musculoskeletal pain conditions pose a significant public health burden because they account for a high proportion of functional limitations, (1) lost workdays, (1) and disability-adjusted life-years. (2) Furthermore, musculoskeletal [...], Objective. Black patients are less likely than White patients to receive physical therapy for musculoskeletal pain conditions. Current evidence, however, is limited to self-reported conditions and health services use. The purpose of this study was to use a large electronic health record database to determine whether a race disparity existed in use of physical therapy within 90 days of a new musculoskeletal diagnosis. Methods. Eligible patients (n = 52,384) were sampled from an Optum deidentified electronic health record database of 5 million adults distributed throughout the United States. In this database, patients were designated as "Black" and "White." Patients were eligible if they had a new diagnosis for musculoskeletal neck, shoulder, back, or knee pain between January 1, 2012, and December 31, 2017. Logistic regression and Cox proportional hazard models were computed before and after adjusting for covariates to estimate the association between race and receipt of physical therapy services within 90 days of musculoskeletal pain diagnoses. Results. Patients were on average 47.5 (SD = 14.9) years of age, 12.8% were Black, 87.2% were White, and 52.7% were female. Ten percent of Black patients and 15.5% of White patients received physical therapy services within 90 days of musculoskeletal pain diagnoses. After adjusting for covariates, White patients were 57% more likely (odds ratio = 1.57; 95% CI = 1.44-1.71) to receive physical therapy compared with Black patients and had significantly shorter time to physical therapy than Black patients (hazard ratio = 1.53; 95% CI = 1.42-1.66). Conclusions. In a nationally distributed cohort, Black patients were less likely than White patients to utilize physical therapy and had a longer time to utilization of physical therapy for musculoskeletal pain. Impact. These findings highlight the need to determine the mechanisms underlying the observed disparities and how these disparities influence health outcomes. Keywords: Musculoskeletal Pain, Physical Therapy Utilization, Race Disparities

Introduction The centennial year of the profession of physical therapy in the United States is an opportunity to reflect on the past to inform the future. Professional formation, as an [...], Professionalism has been the foundation of physical therapy's contract with society, with the American Physical Therapy Association's (APTA) Core Values and Code of Ethics serving as its building blocks. Professional formation has focused on professionalism and has been taught in a manner that is more implicit than explicit in doctor of physical therapy (DPT) curricula. As a domain of competence, professionalism alone has not been broad enough to meet societal needs. In reaching our centennial year, many have reflected on what competencies are needed to move forward. The need for leadership competencies is not new and has been espoused by our leaders over the past 100 years. Some advocate for the adoption of leadership as a unique domain of competence, separate from the domain of professionalism, whereas others propose that either professionalism or leadership is one domain of competence that subsumes the other. The purpose of this Perspective is twofold: to compare and contrast the concepts of professionalism and leadership, and to make recommendations regarding what constitutes domains of competence within the professional formation of physical therapists. This Perspective offers recommendations addressing professional formation and the adoption of leadership and professionalism as 2 distinct domains of competence and discusses educational and clinical implications of the recommendations. This Perspective asserts that these recommendations must be adopted to move the profession forward into the next century so that physical therapists are recognized as adding value to the health care system and the evolving needs of society. Keywords: Domain of Competence, Education: Competency-Based, Leadership, Professional Formation, Professional Identity Formation, Professionalism

Introduction Between one-quarter and two-thirds of adults in the United States and the European Union are estimated to meet published recommendations for moderate to vigorous physical activity. (1,2) The global [...], Physical therapists are uniquely positioned through their knowledge and skills to help people become more physically active, which may reduce the consequences of physical inactivity for health-related quality of life and the global economy. The "Exercise Is Medicine" campaign was introduced in 2007. It holds that exercise may be prescribed like a medicine. Although this analogy doubtlessly has promoted innumerable life-changing conversations between clinicians and patients, there are important shortcomings to considering physical activity and exercise as medicine. In the United States, many of these shortcomings relate to how medical services are provided and remunerated. Medical care is provided in the context of exclusive groups, which are established by insurance, preferred service populations, or other characteristics that determine a basis for providing care. Exclusivity means that medical care is frequently provided in a type of club. The club structure of medical care jeopardizes the ability of nonmembers to benefit. Medical care clubs based on payment create an environment in which nonpaying customers may not benefit in the same manner as paying customers from approaches that consider exercise prescribed as medicine. This clinical perspective reviews the characteristics of exercise as a good, focusing on how it is prescribed by physical therapists. It discusses how physical therapists may become involved in the process of making exercise a public good by reducing its exclusivity. Multiple levels of involvement are recommended at the societal, community, and individual levels. These involvements may be guided by an existing construct proposed by the World Health Organization, which would bring the global physical therapy profession into a common alignment. This Perspective concludes with a discussion that anticipates the shortcomings of conceptualizing exercise as a public good to be addressed in future service delivery models. Keywords: Exercise, Health Economics, Health Policy, Health Promotion, Prevention

Introduction The prevalence of chronic pain worldwide is 30.3%, (1) being one of the most common reasons adults seek medical care. (2) Chronic pain often presents with anxious or depressed [...], Objective. Lack of clarity regarding effective communication behaviors in chronic pain management is a barrier for implementing psychologically informed physical therapy approaches that rely on competent communication by physical therapist providers. This study aimed to conduct a systematic review and meta-synthesis to inform the development of a conceptual framework for preferred communication behaviors in pain rehabilitation. Methods. Ten databases in the health and communication sciences were systematically searched for qualitative and mixed-method studies of interpersonal communication between physical therapists and adults with chronic pain. Two independent investigators extracted quotations with implicit and explicit references to communication and study characteristics following Standards for Reporting Qualitative Research and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality for individual studies was assessed with Critical Appraisal Skills Programme, and quality of evidence was evaluated with GRADE-CERQual. An inductive thematic synthesis was conducted by coding each quotation, developing descriptive themes, and then generating behaviorally distinct analytical themes. Results. Eleven studies involving 346 participants were included. The specificity of operationalizing communication terms varied widely. Meta-synthesis identified 8 communication themes: (1) disclosure-facilitating, (2) rapport-building, (3) empathic, (4) collaborative, (5) professional accountability, (6) informative, (7) agenda-setting, and (8) meta-communication. Based on the quality of available evidence, confidence was moderate for 4 themes and low for 4 themes. Conclusion. This study revealed limited operationalization of communication behaviors preferred by physical therapists in chronic pain rehabilitation. A conceptual framework based on 8 communication themes identified from the literature is proposed as a preliminary paradigm to guide future research. Impact. This proposed evidence-based conceptual framework for preferred communication behaviors in pain rehabilitation provides a framework for clinicians to reflect on their own communication practices and will allow researchers to identify if and how specific communication behaviors impact clinical outcomes. Keywords: Chronic Pain, Communication, Musculoskeletal Pain, Pain Management, Patient-Centered Care, Physical Therapists

WHAT NORMALIZES DISABILITY My child Sammy is such an amazing teacher on so many different levels. He provides these incredible opportunities to reflect on yourself and the world around you. [...]

Null hypothesis statistical tests are often conducted in healthcare research, (1) including in the physiotherapy field. (2) Despite their widespread use, null hypothesis statistical tests have important limitations. This co-published [...]

Introduction Neural mobilization (NM) is a treatment approach that targets the physiology of pain by mechanically manipulating neural tissues and their surrounding nonneural structures. (1) NM comprises 2 different gliding [...], Objective. The purpose of this study was to assess the current evidence for the effects of neural mobilization (NM) treatments. Methods.Three umbrella reviews with meta-meta-analyses were conducted to determine the effects of NM on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in participants who were asymptomatic. The study used the grading criteria proposed by the Physical Activity Guidelines Advisory Committee to assess the quality of evidence. Results. One meta-meta-analysis revealed a statistically significant moderate effect on pain intensity (standardized mean difference [SMD] = -0.75, 95% CI = -1.1 2 t o -0.38) but with evidence of heterogeneity (Q = 14.13; [I.sup.2] = 65%). The study found a significantly large effect of NM on disability (SMD = -1.22, 95% CI = -2.19 to -0.26), again with evidence of heterogeneity (Q = 31.57; [I.sup.2] = 87%). The third meta-meta-analysis showed a statistically significant moderate effect of NM on mechanosensitivity (SMD =0.96, 95% CI = 0.35 to 1.57), with no evidence of heterogeneity (Q =2.73; [I.sup.2] =63%). For all examined outcomes, the quality of evidence was limited. Conclusion. Overall, the results indicated that although NM treatment had a moderate to large beneficial clinical effect on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in individuals who were asymptomatic, the quality of evidence was limited. Impact. Neural mobilization treatments showed positive results on the pain intensity and disability in individuals with musculoskeletal conditions. Neural mobilization could be integrated into the physical therapy management, although more research is needed. Keywords: Disability, Mechanosensitivity, Musculoskeletal Disorders, Neural Mobilization, Neurodynamic Dysfunction, Pain Intensity

Introduction Aerobic capacity is significantly compromised after stroke. (1) In the sub-acute phases of stroke recovery, cardiorespiratory fitness levels are less than one-half of age-referenced values (2-5) and below thresholds [...], Objective. Best practice guidelines recommend that aerobic exercise (AEx) be implemented as early as possible poststroke, yet the prescription of AEx remains limited in stroke rehabilitation settings. This study used theoretical frameworks to obtain an in-depth understanding of barriers and enablers to AEx implementation in the stroke rehabilitation setting. Methods. A qualitative, descriptive study was conducted. Participants were recruited from 4 stroke rehabilitation settings in Ontario, Canada, that have participated in an implementation study to provide structured AEx programming as part of standard care. Six clinician focus groups (with 19 physical therapists and 5 rehabilitation assistants) and one-to-one interviews with 7 managers and 1 physician were conducted to explore barriers and enablers to AEx implementation. The Theoretical Domains Framework and Consolidated Framework for Implementation Research informed content analysis for clinician and manager perspectives, respectively. Results. Barriers specific to resource constraints and health care system pressures, combined with patient goals, led to interventions to improve function being prioritized over AEx. Successful implementation was enabled through an interprofessional approach and team engagement in the planning and implementation process. Health care providers described concerns about patient safety, but confidence and capability for implementing AEx were enabled by education, skill development, use of exercise tests, and consultation with individuals with content expertise. Participants described the development of supportive processes that enabled AEx implementation within team workflows and shared resources. Conclusion. Strategies to support implementation of AEx in stroke rehabilitation should incorporate knowledge and skills, the provision of clinical decision-making tools, access to expert consultation, the roles and social influence of the interprofessional team and formal and informal leaders, and supportive processes adapted to the local context. Impact. Results from this study will inform the development of a clinical implementation toolkit to support clinical uptake of AEx in the stroke rehabilitation setting. Keywords: Aerobic Exercise, Focus Groups, Interview, Physical Therapists, Stroke

Introduction Patients after total knee arthroplasty (TKA) rarely meet agematched norms for strength, function, or activity levels. (1-4) Muscle weakness, ubiquitous prior to and further amplified following TKA, (3,5-8) is [...], Range of motion (ROM) and pain often define successful recovery after total knee arthroplasty (TKA), but these routine clinical outcomes correlate poorly or not at all to functional capacity after TKA. The purpose of this Perspective is to underscore the importance of muscle strength and performance-based functional tests in addition to knee ROM and patient-reported outcome (PRO) measures to evaluate outcomes after TKA. Specifically: (1) muscle strength is the rate-limiting step for recovery of function after TKA; (2) progressive rehabilitation targeting early quadriceps muscle strengthening improves outcomes and does not compromise ROM after TKA; (3) ROM and PROs fail to fully capture functional limitations after TKA; and (4) performance-based functional tests are critical to evaluate function objectively after TKA. This Perspective also addresses studies that question the need for or benefit of physical therapy after TKA because their conclusions focus only on ROM and PRO measures. Future research is needed to determine the optimal timing, delivery, intensity, and content of physical therapy. Keywords: Function, Range of Motion, Rehabilitation, Strength, Total Knee Arthroplasty

Introduction Musculoskeletal conditions remain one of the largest burdens of disease in primary care settings, (1,2) and a central part of the treatment pathway for individuals with musculoskeletal conditions is [...], Objective. A vital part of the initial examination performed by a physical therapist is to establish whether the patient would benefit from physical therapist intervention. This process includes knowledge about contraindications for treatment and screening for serious pathologies. However, little is known about the physical therapists' views and thoughts about their own practice when screening for serious pathologies. The purpose of this study was to explore the experience gained by physical therapists when screening for serious pathologies among their patients. Methods. This was a qualitative study based on individual semi-structured interviews with 9 primary care physical therapists. The interviews were analyzed using reflexive thematic analysis, and generated themes were explained and reported with relevant quotes. Results. Three overall themes were generated: (1) the role of physical therapists in the diagnostic process; (2) responsibility from the individual to the group; and (3) the difficult task of cooperation. The physical therapists described how they relied more on their clinical suspicion than on asking red-flag questions when screening for serious pathologies. They also questioned their differential diagnostic abilities. Finally, they saw a potential to further enhance their confidence in the area by reflecting on the matter with colleagues and by receiving more feedback about their clinical reasoning regarding serious pathologies from general practitioners. Conclusion. These findings suggest that physical therapists primarily rely on their clinical suspicion when screening for serious pathologies but at the same time are uncertain about their differential diagnostic abilities. Impact. These findings can inform future interventions targeting the physical therapists' abilities to detect serious pathology. Keywords: Primary Care, Qualitative, Red Flags, Serious Pathology

Introduction Understanding and predicting which patient will have the best outcomes or respond to a particular treatment has been the priority of many researchers in the physical rehabilitation profession. (1-6) [...], In health care, clinical decision making is typically based on diagnostic findings. Rehabilitation clinicians commonly rely on pathoanatomical diagnoses to guide treatment and define prognosis. Targeting prognostic factors is a promising way for rehabilitation clinicians to enhance treatment decision-making processes, personalize rehabilitation approaches, and ultimately improve patient outcomes. This can be achieved by using prognostic tools that provide accurate estimates of the probability of future outcomes for a patient in clinical practice. Most literature reviews of prognostic tools in rehabilitation have focused on prescriptive clinical prediction rules. These studies highlight notable methodological issues and conclude that these tools are neither valid nor useful for clinical practice. This has raised the need to open the scope of research to understand what makes a quality prognostic tool that can be used in clinical practice. Methodological guidance in prognosis research has emerged in the last decade, encompassing exploratory studies on the development of prognosis and prognostic models. Methodological rigor is essential to develop prognostic tools, because only prognostic models developed and validated through a rigorous methodological process should guide clinical decision making. This Perspective argues that rehabilitation clinicians need to master the identification and use of prognostic tools to enhance their capacity to provide personalized rehabilitation. It is time for prognosis research to look for prognostic models that were developed and validated following a comprehensive process before being simplified into suitable tools for clinical practice. New models, or rigorous validation of current models, are needed. The approach discussed in this Perspective offers a promising way to overcome the limitations of most models and provide clinicians with quality tools for personalized rehabilitation approaches. Impact. Prognostic research can be applied to clinical rehabilitation; this Perspective proposes solutions to develop highquality prognostic models to optimize patient outcomes. Keywords: Decision Making, Clinical Rehabilitation, Outcome Assessment (Health Care), Patient-Centered Care, Prognosis

Introduction Postpartum care in the United States does not adequately manage common physical health issues after childbirth. In 2015, 85% of women in the United States over age 40 years [...], The objectives of this Perspective paper are to educate physical therapists on their important role in assessing and treating common pregnancy- and delivery-related health conditions and to advocate for their routine inclusion in postpartum care during the fourth trimester. Pelvic floor dysfunction (PFD) and diastasis recti abdominis (DRA) are 2 examples of musculoskeletal disorders associated with pregnancy and childbirth that can have negative physical, social, and psychological consequences. This paper reviews evidence from 2010 through 2021 to discuss the efficacy of physical therapist intervention in the fourth trimester for PFD and DRA. The role of physical therapy in the United States is compared with its role in other developed nations, with the intent of illustrating the potential importance of physical therapy in postpartum care. Evidence shows physical therapy is an effective, low-risk, therapeutic approach for PFD and DRA; however, physical therapists in the United States currently have a peripheral role in providing postpartum care. Lack of awareness, social stigma, and policy barriers prevent women from receiving physical therapist care. Recommendations are made regarding ways in which physical therapists can increase their involvement in the fourth trimester within their community, stimulate policy change, and promote improved postpartum care practices. Impact. This Perspective highlights the valuable role of physical therapist assessment and treatment during the postpartum period for some common musculoskeletal conditions associated with pregnancy and delivery. Keywords: Maternal Health, Recti Abdominis, Muscle, Diastasis, Pelvic Floor Disorders, Postnatal Care, Physical Therapy Techniques

Introduction Dementia is a leading cause of disability. (1) With approximately 50 million people living with dementia worldwide, (2) dementia presents a major challenge to not only the individual but [...], Objective. The purpose of this study was to determine physical therapists' and physical therapist students' attitudes and beliefs, knowledge, and confidence in working with people with dementia. Methods. This was a mixed-methods systematic review. Participants included physical therapists working in any clinical specialty and physical therapist students who had completed at least 1 clinical placement. Eleven databases were searched. The evidence was evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were "quantized" using thematic analysis and synthesized with qualitative data using thematic synthesis. Results. Fifteen studies were included (9 quantitative and 6 qualitative studies). Seven key themes evolved. Five related to the belief that (1) working with people with dementia is complex and challenging; (2) opportunities for education in dementia care are lacking; (3) working with people with dementia is a specialized area of practice; (4) there are unsupportive systems for working with people with dementia; and (5) people with dementia deserve rehabilitation, but their potential to improve is less certain. One theme related to knowledge (lack of knowledge in some areas of dementia care), and 1 theme related to confidence (lack of confidence in working with people with dementia). Conclusions. Physical therapists and physical therapist students believe that working with people with dementia can be challenging. The low levels of knowledge and confidence in areas important to working with people who have dementia suggest that more education about dementia is needed. Impact. This mixed-methods systematic review highlights that physical therapists and physical therapist students believe that working with people who have dementia is complex and challenging. Physical therapists want more training and support in this growing area of practice. Keywords: Alzheimer Disease, Dementia, Education: Physical Therapist Students, Physical Therapists

Introduction Chest trauma can be defined as an injury due to an external force that causes disruption to the chest wall or thoracic cavity and injury to the underlying structures, [...], Objective. The purposes of this study were to evaluate the effect of positive expiratory pressure (PEP) therapy on lung volumes and health outcomes in adults with chest trauma and to investigate any adverse effects and optimal dosages leading to the greatest positive impact on lung volumes and recovery. Methods. Data sources were MEDLINE/PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database, CINAHL, Open Access Thesis/Dissertations, EBSCO Open Dissertations, and OpenSIGLE/Open Grey. Randomized controlled trials investigating PEP therapy compared with usual care or other physical therapist interventions were included. Participants were >18 years old and who were admitted to the hospital with any form of chest trauma, including lung or cardiac surgery, blunt chest trauma, and rib fractures. Methodological quality was assessed using the Physiotherapy Evidence Database Scale, and the level of evidence was downgraded using the Grading of Recommendations Assessment, Development and Evaluation approach. Results. Eleven studies involving 661 participants met inclusion eligibility. There was very low-level evidence that PEP improved forced vital capacity (standardized mean difference = -0.50; 95% CI = -0.79 to -0.21), forced expiratory volume in 1 second (standardized mean difference = -0.38; 95% CI = -0.62 to -0.13), and reduced the incidence of pneumonia (relative risk = 0.16; 95% CI= 0.03 to 0.85). Respiratory muscle strength also significantly improved in all 3 studies reporting this outcome. There was very low-level evidence that PEP did not improve other lung function measures, arterial blood gases, atelectasis, or hospital length of stay. Both PEP devices and dosages varied among the studies, and no adverse events were reported. Conclusion. PEP therapy is a safe intervention with very low-level evidence showing improvements in forced vital capacity, forced expiratory volume in 1 second, respiratory muscle strength, and incidence of pneumonia. It does not improve arterial blood gases, atelectasis, or hospital length of stay. Because the evidence is very low level, more rigorous physiological and dose-response studies are required to understand the true impact of PEP on the lungs after chest trauma. Impact. There is currently no strong evidence for physical therapists to routinely use PEP devices following chest trauma. However, there is no evidence of adverse events; therefore, in specific clinical situations, PEP therapy may be considered. Keywords: Physical Therapy Modalities, Positive-Pressure Respiration, Respiratory Therapy

Introduction In the United States, poor health status is now, unfortunately, the norm. An estimated 6 in 10 American adults have at least 1 chronic noncommunicable disease, and 4 in [...], There is a reciprocal relationship between common health conditions encountered in physical therapist practice, disability, and healthy living factors, such as physical inactivity, blood pressure, sleep quality, diet, and obesity. This relationship is apparent across all practice settings. Physical therapists are well positioned in the health care system to mitigate chronic disease by routinely screening and addressing healthy living factors to improve overall health and lower the risk for chronic disease (healthy living medicine). However, there are several challenges to the successful implementation of this framework in physical therapist practice. This Perspective will elucidate this relationship between healthy living behaviors and physical therapist practice, review the current state of practice regarding screening and intervention of 5 key healthy living behaviors, and outline future steps the profession can take toward implementing precision medicine using a healthy living medicine approach. Keywords: Chronic Disease, Healthy Living Medicine, Precision Medicine, Preventive Health Services

2023 SEP 9 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in Obesity, Fitness and Wellness. According to news [...]

2023 JUN 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Cerebrovascular Diseases and Conditions - Stroke have been [...]

2023 JUN 10 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Opioids have been published. According to news originating [...]

2023 APR 29 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in Opioids. According to news reporting originating from [...]

Foundation Offers Record Number of Grants The Foundation for Physical Therapy Research (FPTR) is offering 11 grants totaling over half a million dollars in research grant support. These grants include [...]

Spinal muscular atrophy (SMA) is a devastating disorder caused by mutations in the gene encoding survival motor neuron (SMN), a protein essential to multiple cellular home-ostatic functions. SMN-deficient motor neurons [...], Keywords: Emerging, Therapies, Knowledge, Translation, Rare, Diseases

Following an online yoga program improves physical function in patients with knee osteoarthritis, according to the results of a new randomized control trial. Although pain did not significantly improve in [...]