Poster Hall: Abstracts & Authors

The following posters were selected for inclusion in this year’s poster hall and you may earn additional CE by reviewing the information presented and answering the questions that follow each poster. You may also ask additional questions of the poster authors by email, using the address provided.

To submit your quiz answers for CE, follow this link and transfer your poster quiz answers to the submission form, where it will be scored and the CE credit will be awarded in your personal profile. Please note that you will be asked to sign in to the IPTA website in order to complete the poster quiz and be awarded CE.
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Posters are presented as PDFs. You must complete at least 4 poster quizzes successfully in order to earn 1 hour of CE credit. A maximum of 4.5 hours of CE may be awarded by successfully completing all 18 poster quizzes. These hours count as self study for PT or PTA license renewal.


Multimodal Sensory Coma Stimulation: Value of Partnering with Family in an Intensive Care Unit

Casey Houlihan, PT, DPT;  Sowmya Kumble, PT

Background: Multimodal sensory stimulation has been reported to facilitate improved consciousness in comatose patients. However, it is not always feasible for therapy staff to provide the recommended amount of sensory stimulation. There is also evidence that sensory stimulation provided by family members is more effective than by an unfamiliar staff member. However, engaging family early during acute phase could be challenging due to family availability and their comfort level. The aim of this case study is to demonstrate the efficacy of partnering with family in the early stages after severe traumatic brain injury.

Case Description: Patient is a 25 year old female admitted to the Neuro Critical Care Unit after a fall from 55 feet. She was independent for all functional mobility at baseline, working full time as a crew member on a large ship. Upon admission to the emergency department she was unresponsive with Glasgow Coma Scale [GCS] Score of 5. Imaging demonstrated diffuse traumatic brain injury with left subdural and subarachnoid hemorrhages and extensive facial and skull base and extremity fractures. The patient was intubated and an external ventricular drainage catheter inserted. Brain magnetic resonance imaging demonstrated right middle cerebral artery cerebral infarct.
On day 20 of hospitalization, patient was deemed medically stable to undergo physical therapy evaluation. The patient had bed rest orders and the right upper extremity was non weight bearing with no range of motion [ROM] at the elbow or wrist. The left upper extremity was weight bearing and ROM as tolerated. On evaluation, patient’s Coma Recovery Scale [CRS]- Revised score was 3 (withdrawal of the right lower extremity to noxious stimuli and oral reflexive movement). Treatment included 16 PT sessions over 20 weekdays.
Beginning on day 25 of hospitalization, family was trained on multimodal sensory stimulation which included music, speaking, reading, tactile input, presentation of photos, smell, and taste. Family members were educated on appropriate exercises that could be safely performed utilizing teach back method to ensure that they would be completed correctly, even without skilled supervision. A document to log the type of stimulation provided and amount of time was provided.

Outcomes: Sensory stimulation by family totaled over 18 hours. Over the course of the 49 day hospitalization, GCS score improved from 5 to 10 and CRS-Revised score improved from 3 to 6. Additionally, patient was able to tolerate progressive verticalization. At the time of discharge to a coma stimulation facility, patient required total assist for bed mobility and transfers. She demonstrated eye opening without stimulation, localization to noxious stimuli, and oral reflexive movement.

Conclusion: Family training to provide frequent, meaningful, and graded sensory stimulation coincided with improvements in arousal. Maintenance of stimulation log aided with proper dosage of coma stimulation. Education of family is strongly recommended for early engagement in patient’s care after severe traumatic brain injury. 

Poster #1:  Multimodal Sensory Stimulation: Value of Partnering with Family in an Intensive Care Unit

  1. Early engagement of the family in the intensive care unit is beneficial to provide appropriate multimodal sensory stimulation outside of therapy sessions.
    1. True
    2. False
  2. Which of the following strategies can be helpful in involving family in multimodal sensory stimulation?
    1. Written instructions with reminders of relevant precautions
    2. Teach back method
    3. Stimulation log
    4. All of the above
  3. Family should not be engaged in an in room activity program in the intensive care unit if there are weight bearing or range of motion restrictions.
    1. True
    2. False

Ask a question about this study: 

Clinical Decision Making for a Patient with Concurrent Degenerative Processes Affecting the Lumbar Spine and Hip Joint 

Roy Horton, PT, DPT, OCSKent Irwin, PT, DHS, GCS  

Background: The incidence of degenerative disease at both the lumbar spine (LS) and hip joint increase with age and frequently occur concurrently. Symptoms present in the LS and hip may complicate the clinical presentation and require additional investigations to identify primary and secondary impairments contributing to the individual’s symptoms and activity limitations. Failure to recognize concurrent disease at both the LS and hip may lead to misdiagnosis and possibly ineffective physical therapy treatment. The purpose of this case report is to describe clinical decision making in the examination and treatment of an individual presenting with chronic low back pain (CLBP) and previously undiagnosed hip osteoarthritis (OA). 

Case Description: The patient was a 59-year-old male with CLBP and right hip pain. His Oswestry Disability Index (ODI) was 54% indicating severe disability, low back and right hip numeric pain rating scale (NPRS) were both 5/10. Impairment-based exam findings included: positive bilateral lumbar quadrant testing, right hip joint restrictions limiting hip motion in all planes, anterior hip soft tissue restrictions, and a positive Flexion Abduction External Rotation test on the right. Magnetic resonance imaging available at the time of examination confirmed the presence of L4/L5 facet arthropathy. Primary impairments were determined to be right hip mobility and anterior soft tissue restrictions with secondary impairments consisting of lumbar spine extension limitation as well as gluteal muscular strength deficits in newly acquired range of motion. Physical examination revealed findings consistent with chronic lumbar facet arthropathy and right hip OA. The primary physical therapy interventions consisted of low and high velocity joint manipulation, stretching, and strengthening exercises to address right hip impairments contributing to altered movement patterns during functional mobility tasks (such as sit to stand transfers and gait). 

Outcomes: At discharge, following 8 physical therapy treatment sessions, the patient demonstrated improvements in lower back and right hip NPRS from 5/10 to 0/10 (MCID = 2 points), lifting and gait tolerances, and ODI scores from 27/50 (54%), severe disability to 8/50 (16%), minimal disability (MCID = 12.8 points). Right hip mobility restrictions were significantly improved in the sagittal and transverse planes. At session 6, a Global Rating of Change Score of +7 was obtained, indicating the patient’s perception of feeling “a very great deal better.” Towards the final physical therapy session, the patient followed up with his primary care physician, received bilateral hip x-rays, and was diagnosed with severe right hip OA. 

Discussion: Clinical decision making in the presence of concurrent LS and hip symptoms is often difficult due to the overlapping referral patterns and intricate interaction between the lumbopelvic region and the hip. This case report demonstrates how a physical therapist’s recognition of coexisting disorders can improve physical therapy management. Accurate identification of primary and secondary impairments contributing to altered movement patterns resulted in positive patient-centered outcomes. This case report supports how an impairment-based treatment approach directed at the hip joint can lead to favorable outcomes in a patient with a primary compliant of CLBP. 

Poster #2:  Clinical Decision Making for a Patient with Concurrent Degenerative Processes Affecting the Lumbar Spine and Hip Joint 

  1. The incidence of degenerative disease at both the lumbar spine and hip joint increase with age and:
    1. Always occur at the same time
    2. Frequently occur at the same time
    3. Never occur at the same time
  2. Following 8 sessions of physical therapy focusing on manual therapy techniques, the patient’s Oswestry Disability Index score:
    1. Did not change
    2. Changed from moderate disability to minimal disability
    3. Changed from severe disability to moderate disability
    4. Changed from severe disability to minimal disability
  3. During the first 4 sessions, the primary manual therapy interventions utilized were targeted at the:
    1. Lumbar spine
    2. R coxafemoral joint
    3. Thoracic spine
    4. Soft tissue mobilization

Ask a question about this study:

A Powerful Therapeutic Alliance to Overcome Barriers Treating a Patient with Complex Neurological Dysfunction in Acute Care Physical Therapy 

Karlie Bless, PT, DPT; Kent E. Irwin, PT, DHS, GCS; Elizabeth Campione, PT, DPT, CLT-LANA 

Background and Purpose: Eighteen percent of scheduled acute care physical therapy appointments do not occur secondary to patient refusal mainly due to decreased patient motivation and a negative rapport with the physical therapist (PT). A strong patient – PT therapeutic alliance significantly increases patient participation and provides opportunities for improved patient outcomes. Empathy, friendliness, confidence, non-verbal communication, active listening, and encouragement are essential components in establishing a therapeutic alliance. The purpose of this case report is to describe how a positive therapeutic alliance created resilience to overcoming internal and external barriers in treating a patient with complex neurological dysfunction in the acute care setting.

Case Description:

The patient was a 27-year-old female who underwent a sleeve gastrectomy procedure due to morbid obesity with subsequent progressive sensorimotor polyneuropathy within one month of surgery, which significantly decreased her functional mobility and societal participation. Although a differential diagnosis of micronutrient deficiency versus Guillain-Barre syndrome (GBS) was considered, the specific etiology of the sensorimotor polyneuropathy was unknown for the majority of her acute care hospitalization. Prior to surgery, the patient was independent with all ADLs and IADLs. She lived alone in a fifth floor apartment and worked as a technician at a plasma clinic, which required prolonged sitting and standing, fine motor coordination, and repetitive upper extremity movement. The patient initially displayed a depressed mood, a high external locus of control, decreased motivation, and lack of trust in the PT as the patient experienced a fall at an outside hospital while in physical therapy.

Examination revealed suboptimal cardiovascular endurance, severe bilateral distal extremity weakness, bilateral sensory deficits in the distribution of the medial and lateral plantar nerves, 7/10 lower extremity pain on the Numeric Pain Rating Scale (NPRS) with weight bearing activities, and decreased lower extremity ROM. The patient required maximum assistance of two PTs for supine to sit transfers and needed a Hoyer lift for bed to chair transitions. The PT recognized that establishing a strong therapeutic alliance would be crucial to increase patient trust, motivation, and participation.

Intervention: A variety of therapeutic interventions were used to decrease pain, increase strength, and improve function for this patient including pressure relief, positioning techniques, ROM activities, bed mobility, and transfers. A sit-to-stand battery-powered mobility device assisted the PTs in safely attempting sit-to-stand transfers with this patient. However, the absence of proper bariatric accessories for this device made it difficult to properly utilize in the treatment sessions. A therapeutic alliance was intentionally developed on the basis of active listening, patience, communication, encouragement, education, integrity, compassion, and caring which are key attributes of the APTA Core Values. These strategies decreased the patient’s anxiety and distrust in the healthcare system by improving communication between the patient and healthcare providers.

Outcomes: After 11 visits of physical therapy, the patient demonstrated improvements in supine-to-sit transfers and increased upper and lower extremity strength. Pain continued to be a limiting factor as her NPRS score reduced from 7/10 to 6/10 (MCID = 1.7). Her Activity Measure for Post-Acute Care (AM-PAC) 6-Clicks score decreased from 10/24 to 8/24 (MCID = 3.3-5.1). Although the patient demonstrated slight improvements in functional mobility, a strong therapeutic alliance developed as evidenced by the patient’s willingness to ultimately undergo appropriate medical tests that led to the diagnosis of acute inflammatory demyelinating polyneuropathy, a form of GBS. Because of the patient’s increased motivation in therapy participation and a stronger internal locus of control, she agreed to be discharged to the acute rehabilitation setting for further therapies.

Discussion: Several modifiable and non-modifiable barriers were present during this episode of care including the patient’s morbid obesity, high external locus of control, decreased motivation, learned helplessness, initial patient distrust of the PT, absence of appropriate bariatric equipment, lack of communication between healthcare providers, and an unknown medical diagnosis. The PT developed a strong therapeutic alliance with the patient through management of patient expectations, individualized therapeutic interventions, patient-provider partnership, identifying the roles and responsibilities of the PT, congruence, and strong verbal and non-verbal communication. The present case demonstrates the power that a therapeutic alliance has on a patient’s willingness to participate in treatment and mediate obstacles in physical therapy. 

Poster #3:  A Powerful Therapeutic Alliance to Overcome Barriers Treating a Patient with Complex Neurological Dysfunction in Acute Care Physical Therapy

  1. What are the essential components of a therapeutic alliance?
    1. Patient expectations, personalized therapy, partnership, congruence, and communication
    2. Both parties require similar personality traits to form a trusting bond
    3. Therapist assertiveness, provide general treatment techniques, and communication
  2. Which disorder is associated exclusively with polyneuropathy?
    1. Multiple Sclerosis
    2. Guillain-Barre Syndrome
    3. Amyotrophic Lateral Sclerosis
  3. Why do most patients refuse physical therapy services in the acute care setting?
    1. Lack of education on physical therapy
    2. The physical therapist arrives unannounced
    3. Lack of patient motivation and a lack of rapport with the physical therapist

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Blood Flow Restriction Training on Lower Extremity Function: A Scoping Review of Effectiveness, Appropriateness, and Implementation on Muscle Hypertrophy, and/or Strengthening during Rehabilitation

Cody Brinkman, SPT; Joline Chang, SPT; Scott L. Getsoian, PT, DPT, DHSc, OCS, MTC, FAAOMPT; Tim Rylander, PT, EdD, MPT, OCS, CSMT, CBIS 

Description: Blood flow restriction is a technique that can be used with low-intensity resistance exercise as an adjunct to physical therapy treatment for improving muscle strength and/or hypertrophy.

Method: A scoping review was conducted to determine the effectiveness, appropriateness, and implementation of blood flow restriction training on lower extremity muscle strength and hypertrophy. After a thorough and exhaustive review of 1,474 records, 20 studies were determined eligible based on the inclusion criteria (studies from 2010 to current, written in English, subjects at least 16 years of age, musculoskeletal conditions of the lower extremity resulting in decreased muscle strength and/or hypertrophy, participation in some form of rehabilitation, the use of blood flow restriction treatment, and various forms of publication). The studies were broken up into quantitative studies (study characteristics, subject characteristics, BFR protocol, intervention parameters, treatment time, and outcomes section) and qualitative studies (BFR safety/adverse events, implementation, indications/contraindications, BFR mechanisms, and current protocols/evidence).

Results: Despite variability among equipment used, treatment time, BFR protocol, and intervention parameters, the majority of studies showed BFR as a beneficial intervention for improving muscle strength and/or hypertrophy.

Conclusions: The qualitative studies provided insight on how to promote safety and reduce the risk of adverse events as there is currently inconsistency in treatment methodology and implementation, which can cause an increase in risk to the patient. Current protocols are evidence-based but future research is still needed to assist in standardization of BFR mechanisms and best practice for specific conditions. 


Capturing changes in Tandem Gait for Individuals with Neurological Impairment: A Case Series

Andrew J Strubhar, PT, PhD, Andrew Knight, SPT, Anna Wong, SPT 

Background & Purpose: Individuals with neurological impairments often have difficulty with dynamic balance and gait. Common measures of gait, such as speed, distance, step and stride length, may not capture indices that reflect changes in dynamic balance during gait, particularly if the patient compensates in gait with a wide base of support. Challenging patients with tandem gait (heel to toe walking on a single line) may bring out impairments of postural control during gait. What is unclear is whether measures of tandem gait, such as speed, sway, and the number of errors, are appropriate measures that can reflect change over a course of physical therapy. The purpose of this study was to explore whether measures of tandem gait (speed, sway, and errors) were appropriate to capture an overall change in dynamic gait ability after a course of physical therapy.
Participants: Five individuals from Bradley University’s pro bono clinic who have chronic impairments secondary to a neurological condition (3 post-CVA and 2 Parkinson’s disease) volunteered to participate. All were ambulatory with no more than contact guard assistance for at least 15 feet.
Methods: As part of the initial evaluation the 5 participants ambulated twice normally and twice in tandem while gait data was being collected with the VirtuSense gait analysis system. The data capturing distance was 12 feet and they ambulated between parallel bars. In addition, during the tandem gait, the number of errors were counted. An error was defined as the entire foot coming off a two-inch-wide piece of tape or their hand touching one of the parallel bars. This procedure was repeated after 10 weeks of 2 times a week physical therapy treatment of their neurological impairments and functional limitations. The interventions during this period were related to the patient’s individual goals and were not manipulated as a part of the study. 
Results: One individual had significant and uncharacteristic difficulties during the post-treatment measurements and thus was not included in the final data. The percent change of the gait parameters from baseline to post-treatment were calculated. The sway data in some of the trials were collected as extremely high values (out of what could be conceived as physiologically possible) thus sway data was not included since it did not appear valid. Changes in normal gait speed across subjects 1,2,3 and 4 were: +15.0%, +13.8%, -5.3% and +8.7%. Changes in normal average step length were: + 13.9%, +21.0%. +11/8% and +20.1%. Changes in tandem gait speed were 53.8%, -37.5%, -23.1% and +16.7%. Changes in tandem gait error (positive reflects less error) were: +35.7%, +25.0%, +28.6% and +9.52%.
Conclusions: There was no difference between cue groups, however the results indicate a significant difference when considering age and previous knowledge of the lumbar multifidus muscle. Subjects less than or equal to 30 years old performed significantly better regardless of the cue provided. Subjects who have no previous knowledge of this muscle responded significant better to the predominately visual cue. Therefore, clinicians may consider investing in an anatomical model that includes the multifidus to educate patients and provide visual feedback regarding the contraction. Patients older than 30 years oldGenerally normal gait improved over the course of 10 weeks as measured by speed (except for one subject) and step length indicating a positive impact from the physical therapy intervention. Tandem gait speed increased in 2 of the subjects whereas in all 4 subjects less error was recorded in the post-therapy measures again perhaps indicating a positive impact of the 10 weeks of therapy. Though we were not able to use the sway data, other research indicated that sway may increase with gait speed. In our general observation, sway may have increased during the post-treatment measures as the subjects were better able to use their trunk to make postural adjustments without having to use their hands or step off the line. In some subjects, better accuracy may have resulted in decreased speed and in some subjects, speed and accuracy in tandem gait improved. Overall, tandem gait measures, especially the number of errors, may be a conceptually valid tool of overall gait improvement in ambulatory individuals with neurological impairments. This research suggests that a larger study may be warranted.  may require more education, training time, or additional cues to produce an effective contraction.


Neurostatus Changes in Patients with Multiple Sclerosis following an Exercise Program: A retrospective analysis

Andrew J Strubhar, PT, PhD; Tim Prosek SPT; Evan Miles SPT 

Background: Research indicates that functional exercise training in individuals with Multiple Sclerosis (MS) will likely result in improved function such as in ambulatory ability. What is unclear is if exercise training in individuals with MS will also drive improvements in their neurological impairments such as strength, tone, sensation, oculomotor function, etc. The purpose of this study was to explore the neurological status of individuals with MS as they participated in an exercise program.

Methods: Ten subjects were originally placed in a control group (stretching exercises) and 11 subjects were placed in an intervention group (resistance, aerobic, and balance exercises). Each group participated for 6 months. Only 9 in each group had enough retrospective data to analyze. Specific to this retrospective analysis, all subjects were measured pre and post with the Kurzke Neurostatus tool that measures specific neurological impairments. These measures were not included specifically in the original research except to inform the EDSS. A change score was created across the specific neurological areas from pre to post for each subject and the categories were mathematically added to produce a magnitude of changes score. A change score was calculated for gait velocity and the 6-minute walk test (6MWT).
Examination revealed suboptimal cardiovascular endurance, severe bilateral distal extremity weakness, bilateral sensory deficits in the distribution of the medial and lateral plantar nerves, 7/10 lower extremity pain on the Numeric Pain Rating Scale (NPRS) with weight bearing activities, and decreased lower extremity ROM. The patient required maximum assistance of two PTs for supine to sit transfers and needed a Hoyer lift for bed to chair transitions. The PT recognized that establishing a strong therapeutic alliance would be crucial to increase patient trust, motivation, and participation. 
Results: A significant difference was not found between the mean Neurostatus change score for the experimental (M=2.85) and control (M=-0.35) groups (t=0.95, p=1.79, d=0.45). Likewise, there was no significant difference (t=1.58, p=.067, d=.74) in the 6MWT change but there was a significant difference between the experimental and control groups for gait velocity (t=2.66, p=.009, d=1.25). There was no significant correlation between Neurostatus change and gait velocity or Neurostatus change and 6MWT, however, there was a significant correlation between gait velocity and the 6MWT.
Discussion and Conclusions: Several modifiable and non-modifiable barriers were present during this episode of care including the patient’s morbid obesity, high external locus of control, decreased motivation, learned helplessness, initial patient distrust of the PT, absence of appropriate bariatric equipment, lack of communication between healthcare providers, and an unknown medical diagnosis. The PT developed a strong therapeutic alliance with the patient through management of patient expectations, individualized therapeutic interventions, patient-provider partnership, identifying the roles and responsibilities of the PT, congruence, and strong verbal and non-verbal communication. The present case demonstrates the power that a therapeutic alliance has on a This specific secondary analysis does not support the notion that 6 months of more intensive resistance, aerobic, and balance exercise produces changes in specific neurological impairments in ambulatory individuals with MS, despite seeing improvements in gait velocity. Improvements after exercise in individuals with MS may be related to other physiological factors, such as cardiovascular improvements, and not related to changes in neurological function. The small sample size was a limitation of this retrospective analysis. patient’s willingness to participate in treatment and mediate obstacles in physical therapy.


Instrument Assisted Soft Tissue Mobilization: Effects on Cervical Motion and Movement Control in Postural Neck Pain 

Courtney Smith, SPT; Ashley Bray, SPT, ATC; Jacquelyn Hengler, SPT; Janey Prodoehl , PT, PhD 

Background and Purpose: Postural neck pain may be associated with myofascial trigger points in neck muscles which can lead to changes in neck mobility and muscle activation. Instrument assisted soft tissue mobilization (IASTM) is one form of soft tissue mobilization used by physical therapists to address these types of soft tissue changes, but there is a lack of high-quality evidence to support its effects. This study aimed to investigate the immediate effects of IASTM on cervical range of motion, pressure pain threshold and muscle strength of the upper trapezius in individuals with postural neck pain.

Methods: Eleven subjects with postural neck pain participated in this study. Subjects underwent pre-treatment testing of cervical range of motion (CROM); muscle strength testing of bilateral upper trapezius, anterior deltoid, middle deltoid, and serratus anterior; electromyography (EMG) of these muscles during fast and slow arm movement; and pressure pain threshold (PPT) testing in three locations. A 5-minute IASTM treatment to the right upper trapezius was performed, and post-testing was completed. Outcomes of interest were CROM, PPT, strength, EMG amplitude during movement, and global rating of change.

Results: CROM generally increased in all directions following treatment, but was only statistically significantly greater in flexion, left side-bending, and left rotation. These increases in CROM were clinically significant. No statistically significant changes were found in strength or upper trapezius EMG amplitude during either slow or fast arm movement immediately following IASTM treatment. There was a statistically significant decrease in PPT for the right forearm but not the upper trapezius muscles following treatment. Global rating of change showed clinically relevant improvement immediately and 24 hours post treatment.

Conclusion: A single bout of IASTM can improve CROM immediately following treatment to a clinically relevant degree, although it does not appear to affect movement control. 


Telehealth and Physical Therapy: Provider Perceptions Amid the COVID-19 Pandemic 

Benjamin Davis, PT, DPT, CSCS; Macey Thornburg, PT, DPT; Josie Kautsky, PT, DPT; James Moore, PT, PhD 

Background and Purpose: Health service delivery may take many forms. One such form, a hallmark of orthopedic physical therapy, is close collaboration between patient and provider in the clinic. However, amid the COVID-19 Pandemic, many clinics have closed their doors, significantly altering physical therapy delivery models. Telehealth is a delivery method that has seen tremendous growth during this time. Until recently, telehealth had not been widely employed in physical therapy, and research is limited to a few conditions. Further, although patient perceptions of telehealth have been investigated, research on provider perceptions is limited. No identified studies have investigated perceptions of orthopedic physical therapists, specifically in light of COVID-19 and its impact on service delivery in Florida. Telehealth use has grown rapidly, and it is arguably being used more than ever before. Therefore, the purpose of the present study was to explore perceptions held by orthopedic physical therapists on telehealth with the intent of determining its role in health care delivery.

Number of Subjects: Sixty-eight.

Materials and Methods: The present study used an internet-based survey that was distributed via email to members of the Florida Physical Therapy Association (FPTA) and to physical therapists affiliated with the University of Miami Health System (UHealth). The survey was comprised of three sections: demographics, training and utilization patterns, and perceptions. Descriptive statistics were generated. Perceptions were captured using a 5-point Likert scale and free response. Level of agreement was calculated using a strategy from prior research.

Results: Sixty-eight physical therapists from 14 counties in Florida completed the survey. The participants represented six specialties, and 44 participants were identified as treating orthopedic conditions. Among them, there was consensus agreement that telehealth improves access to health services (89%), makes scheduling more flexible (82%), and is best administered as an adjunct (80%). A majority of participants felt they have sufficient experience (73%) and knowledge (66%) to deliver telehealth services. However, fewer participants agreed that telehealth is effective (68%), is cost-effective for the organization (50%), and is cost-effective for the patient or caregiver (25%). Few participants agreed that telehealth is an adequate replacement for in-person appointments (20%).

Conclusions: Telehealth was perceived to reduce barriers to care, and therapists felt prepared to deliver the service. Yet, despite perceived advantages, fewer therapists agreed on telehealth’s effectiveness and many questioned it as a substitute for traditional physical therapy. These findings may indicate a role for telehealth in health care, though its specific role has yet to be determined.

Clinical Relevance: While orthopedic physical therapists may be willing to provide telehealth services, they may prefer a more traditional approach in the clinic. They may consider services delivered via telehealth as supplementary, rather than as a substitute. Greater exploration of telehealth may clarify its role in comprehensive physical therapy care. 


Is Prone Positioning Effective in Improving Hypoxemia for Non-ventilated Patients with Covid-19? A Rapid Evidence Assessment 

Kathryn Kazmierczak, SPT; Klair Holmes, SPT; Kent E. Irwin, PT, DHS, GCS; , Christian C. Evans, PT, PhD

Background: A relatively high percentage of patients with Covid-19 develop hypoxemia and must be ventilated. While prone positioning (PP) has been shown to be effective in improving peripheral oxygen saturation (SpO2) in ventilated patients with hypoxemia, whether it is effective in non-ventilated patients with Covid-19 is not known. The purpose of this rapid evidence assessment (REA) was to examine the effectiveness of PP on SpO2 for non-ventilated adults with COVID-19 and hypoxemia.

Methods: PEDro, Medline Complete, and Cochrane Central Register of Controlled Trials were searched. Inclusion criteria were non-ventilated adults, diagnosed with Covid-19, and treated with PP. Exclusion criteria were patients on mechanical ventilation and <18 years old. The primary outcome was SpO2. Methodologic quality was appraised using the SIGN Methodology Checklist 3.

Results: Eight studies met all inclusion/exclusion criteria and a total of 199 patients were included. All studies were cohort design and four of eight met the acceptable threshold for risk of bias. All four of the studies that reported SpO2 found an increase in post- compared to pre-PP.

Conclusion: Due to heterogeneity in methods and outcomes, as well as varied results, we conclude there is moderate support that PP improves SpO2, but not all individuals benefit. Additional well-controlled randomized clinical trials are needed to confirm these findings. Given the limited data available at this time, PP is recommended as a management strategy for non-ventilated patients with Covid-19 with hypoxemia. 


Perceptions and Attitudes of Physical Therapy Students Regarding Onsite Clinical Site Visits 

Kevin Au, SPT; Erika Eiesland, SPT; Colton Emmerich, SPT; Taylar Harris, SPT; Mikalyn Johnson, SPT; Sarah Scheldrup, SPT; Leigh (Taylor) Steele; SPT, Patrick Withrow PT, DPT

Description and Purpose: Clinical education experiences are a significant component of DPT education curricula. Site visits are an important tool for assessment and communication amongst all stakeholders including students, CIs, faculty, and clinical education sites. The primary purpose of this study was to investigate the degree to which students and recent graduates value in-person clinical site visits. The secondary purpose was to provide preliminary data that can be used for further research into a cost-benefit analysis of site visits.

Methods: This study utilized a survey that was sent out to students and graduates from the classes of 2018-2021 at one DPT program. Inclusion criteria required that subjects had at least one in-person clinical site visit and had completed 2 or more full-time clinical education experiences. Out of the 199 subjects recruited, 39 completed the survey (20% response rate), which consisted of 32 items. The survey included several demographics questions, 4-point Likert scale items, and free-response items. SPSS software was used to cross analyze demographic and Likert scale questions. APTA membership status and gender were compared using the Mann Whitney U Test. Comparison of graduating class and the number of in-person site visits was done using the Kruskal-Wallis Test.

Results: 79% of respondents preferred in-person site visits when compared to other forms such as telephone or email, and the majority favored a visit every time a clinical education experience occurred. 97% agreed that in-person visits improved communication between students and the program, and 95% agreed that in-person visits improved communication between students and CIs. A majority of students indicated that an in-person visit did not improve their clinical performance.

Conclusions: DPT students and recent graduates had a positive perception of in-person site visits compared to other visit methods. In-person visits may be helpful in maintaining communication among clinical education stakeholders. Further research is needed to explore ways in which in-person site visits affect clinical education experiences from the perspective of the student. 


Comparison of a Pain Education Intervention to a Pain Education and Movement Intervention on Adults with Persistent Pain: A Randomized Control Trial Pilot Study 

Jeffrey A. Damaschke PT, DPT, PhD, OCS; Kyle Negangard SPT; Kaitlyn Urick SPT; Erin McNulty SPT; Nina Zdanowicz SPT; Hannah Lasky SPT; Elicia Kleich SPT

Purpose: The purpose of this study was to determine if pain education with movement education had a greater effect on improving quality of life in individuals experiencing persistent pain, compared to pain education alone, based on patient reported outcomes.

Methods: Subjects were randomized into two groups. The intervention groups included pain education (Group A) and pain education with movement education (Group B). Each group completed pre-intervention surveys that measured dimensions of quality of life, including: Fear of Pain Questionnaire-III (FPQ III), Medical Outcomes Study Short Form-12 (SF-12), Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Participants completed post-intervention surveys 4 weeks after the initial education sessions.

Results: 15 participants completed the study. Group B displayed a significant improvement in PHQ-9 scores from pre to post-intervention. Both groups showed a trend of improved scores from pre to post-intervention, though Group B demonstrated a greater improvement in outcome measure scores. Group B had a large effect size for the PHQ-9 and VT SF-12 scores.

Data Analysis: Data obtained from both groups’ pre and post-scores of FPQ III, SF-12, PHQ-9, and GAD-7 were entered into SPSS version 25.0, and were analyzed using the Wilcoxon signed rank test. Effect size was then calculated by dividing the z-score [obtained from SPSS analysis] from each outcome measure by the square root of the sample size (N) of both groups.

Conclusions: The results of this study indicate that pain neuroscience education with an exercise intervention may be more effective in improving quality of life than pain neuroscience education alone. Due to the small number of participants and the specific population recruited, the results cannot be applied to the general population; this study may guide further research to further confirm study findings. 


Recognizing the Relevance of Contextual Factors in effort to Enhance Patient Outcomes in the Inpatient Acute Rehabilitation Setting: a Retrospective Case Report 

Kaitlyn Chambers, SPT; Maryleen K. Jones, PT, DHS, DPT, NCS, CLT; Roberta O’Shea, PT, DPT, PhD

Background and Purpose: Evidence suggests that functioning is a context-dependent phenomenon, yet there is little research that outlines how contextual factors can be integrated into the care plan. Furthermore, research has observed that predictors of discharge against medical advice (AMA) are independent of condition or impairments. The purpose of this retrospective case report was to recognize the relevance of contextual factors and propose additional strategies that may have led to more favorable patient outcomes.

Case Description: The study took place in the acute inpatient rehabilitation facility (IRF). Patient was a 36-year old male who had presented to the emergency department with arm pain at injection site post heroin drug use and was admitted to the hospital for treatment. One day later, he was found unresponsive. Imaging revealed an extensive subarachnoid hemorrhage. The patient underwent surgery and remained in acute inpatient until he transferred to the IRF.

Outcomes: This patient’s functional gains were limited by his in-attention and impulsivity. He discharged AMA stand-by-assist or contact-guard-assist in most functional activities, but required 24-hour-assistance and supervision to ensure optimal patient welfare. Further root cause analysis discovered that this patient’s contextual factors played a primary role in his outcome.

Discussion: The multidisciplinary team failed to comprehensively identify and incorporate this patient’s contextual factors and predictors of AMA discharge into the care plan. Consequently, the team missed an opportunity to decrease his risk of an AMA discharge and to enhance his outcomes. Strategies like shared decision-making, error augmentation and attention training frameworks, and referrals will be discussed.


Vestibular Rehabilitation Following Acoustic Neuroma Resection Surgery in a Patient with a Unilateral Vestibular Hypofunction (UVH) Secondary to Transcranial Laminotomy: A Retrospective Case Report 

Jessica Song, SPT; Maryleen K Jones, PT, DHS, CLT, NCS; Steven Tijerina, PT, DPT, Cert. MDT, Cert. VRT 

Description and Purpose: Patients can experience vestibular symptoms if a common benign tumor, an acoustic neuroma, develops of the eighth cranial nerve. Subsequently, surgery results in dizziness, postural instability, and oscillopsia. The aim of this case study is to see the effectiveness of applying early physical therapy clinical guidelines of vestibular rehabilitation for a patient with unilateral vestibular hypofunction (UVH) secondary to a transcranial laminotomy.

Case Description. The patient was a 64-year-old male who had a referral for vestibular rehabilitation therapy following an acoustic neuroma resection. He had no prior history of heart conditions, vestibular problems, or diabetes. He was an active gentleman who participated in golf recreationally and walked daily. PT consisted of mechanisms for adaptation, gain in vestibular ocular reflex, and habituation.
Outcomes. The patient was treated in an outpatient setting for a total of 8 sessions. The patient saw significant improvements in his vestibulocular reflex (VOR), balance, and gait stability every week. After 8 sessions of receiving vestibular physical therapy services, the patient demonstrated improved Activities-Specific Balance Confidence (ABC), Dizziness Handicap Inventory (DHI), Dynamic Gait Index (DGI), and Functional Gait Assessment (FGA) outcomes.

Discussion. Vestibular rehabilitation therapy (VRT) guidelines for unilateral vestibular hypofunction (UVH) were used to model interventions for this case study. The effectiveness of VRT treatment for the client profiled in this case report confirmed the utility of applying early VRT to an older patient with UVH secondary to transcranial laminotomy. 


Implications of Clinical Reasoning on Implementation of the Human Movement System: A Comparison of Student and Licensed Clinicians 

Margaret Thon, PT, DPT; Jeffrey Thompson, PT, DPT; Melissa L. Peterson, PT, PhD, GCS; Brenda Pratt, PT, DSc; Jamie Way, PT, DPT 

Purpose/Hypothesis: The purpose of this study was to compare the clinical decision-making skills of physical therapy students to a licensed therapist while using the Human Movement System evaluation in a neurologically involved patient population.

Number of Subjects: Forty-six second- and third-year Doctor of Physical Therapy students and one licensed physical therapist with 11 years of experience participated in the study.

Materials and Methods: Students conducted initial evaluations for twelve individuals with neurologic diagnoses being treated at a university-based pro bono clinic. Evaluations were conducted using a Movement System evaluation form with 8 diagnoses based on the work of Scheets and colleagues. Each client was evaluated by two 2nd-year and two 3rd-year DPT students simultaneously but independently. Each student determined the most appropriate Movement System diagnosis and reported it to researchers. An experienced clinician then made an independent Movement System diagnosis after reviewing objective data (manual muscle test grades, range of motion, sensation) and video of all examination components, including transfers, gait, and balance and provided rationale to researchers. Follow-up interviews were conducted by researchers to gather qualitative data regarding students’ rationale for selecting the diagnosis. Comparisons were made between students’ and clinician’s classifications and rationale.

Results: While Force Production Deficit was chosen most frequently, the students chose it for 61% of clients compared to 46% for the clinician. In contrast, the clinician chose Movement Pattern Coordination Deficit more frequently than did the students (36% vs. 17%). The clinician and 22% of students described a comprehensive clinical-decision making approach, considering quality of movement and underlying contributing deficits, but many students described choosing a diagnosis based on the most obvious findings, such as weakness.

Conclusions: Both students and the clinician were able to use the Human Movement System classifications to identify primary movement deficits for individuals with neurologic diagnoses. However, the practicing clinician provided superior clinical reasoning both ruling in and ruling out potential movement deficits. The student physical therapists tended to choose the more obvious FPD diagnosis due to it being the most apparent impairment, regardless of whether the lack of force production was due to a different movement deficit.

Clinical Relevance: The Human Movement System classification provides a framework for evaluating the movement deficits in individuals with neurologic conditions. Instruction and practice is required in order for novice students to develop a comprehensive approach for evaluation, diagnosis, and intervention. 


Confidence and Perceived Role of Physical Therapists in Treating Patients Who are Presenting Pre- and Postpartum in the Outpatient Setting: A Survey Study 

Natalie Turrentine PT, DPT, OCS,MSHA; Lauren Deets, SPT; Jacqueline Harris, SPT; Dominka Manko, SPT; Cassidy McFarlane, SPT; Alyssa Minnicino, SPT; Abigail Thompson, SPT 

Description: The purpose of this study was to assess the confidence and perceived role of outpatient physical therapists (PTs) in treating patients who are pre- and postpartum. Outpatient PTs were recruited to complete a 42-item survey which asked: 1) demographic profile and area of specialty, 2) level of confidence in treating select pathologies, 3) to rank the appropriate PT specialty to treat pre- and postpartum patients with pathology. Descriptive statistics evaluated demographic and board-certified specialty, confidence level, and specialties ranked first. Kruskal-Wallis evaluated if there was a difference in confidence levels between specialties when treating patients at each trimester, two months, and six months postpartum. Chi-Square (One Sample) test evaluated if PTs believe their specialty is most qualified to treat various conditions in patients who are pre- and postpartum. The survey received a completion rate of 81% (N = 606). 1) Specialty demographics included 85 orthopedic, 93 women’s health, and 388 with any other/no specialty. A statistically significant difference was found in 2) confidence levels between specialty groups. 3) Women’s health specialists were ranked as the most qualified to treat all conditions in patients both pre- and postpartum, except for wrist/hand pain and foot/ankle pain. Chi-Square determined the ranking did not occur due to chance alone. Participants across all specialty groups disagreed that patients receive adequate evidence based education during pregnancy (87%) and after pregnancy (96%). The majority of PTs believed that patients are unaware of physical therapy as a treatment option and they do not receive adequate evidence-based patient education during and after pregnancy. Our findings suggest there is a need for patient, PT, and interprofessional healthcare professional education on the benefits of pre- and postpartum physical therapy. 


The Effects of a Maternity Support Binder on Gait and Balance in Women
during the Third Trimester of Pregnancy 

Joashly Calingacion, SPT; Anne Havenga, SPT; Christine Leszczewicz, SPT; Megan Mink, SPT; Stacie Bertram PT, PhD 

Background: Pregnant women are at higher risk of falling, particularly in the final trimester. Falling is particularly dangerous for this population because it can cause injury to the mother or the fetus. Compression has been linked to improved balance, but there is unclear evidence on the effect of a maternity support binder (MSB) on balance in pregnant women.

Objectives: The purpose of this study is to determine the effects of a MSB on gait and balance in pregnant women in the third trimester.
Study Design: This is a repeated measures study.

Methods: Eight women in the third trimester of pregnancy performed 4 balance indicators with and without a MSB: Timed Up and Go (TUG), Gait analysis, Functional Reach and Modified Clinical Test of Sensory Interaction on Balance (mCTSIB).

Results: Average sway during gait decreased about 0.92 cm and TUG velocity improved .09 seconds on average while wearing the binder. For the mCTSIB, participants wearing the MSB demonstrated a decreased sway of 1.14 in. during the eyes open position and 1.31 in. during the eyes closed position, but an increased sway of 0.53 in. during the eyes open on foam position and 1.18 in. during the eyes closed on foam position on average. The average distance achieved during the Functional Reach test showed no differences with or without the binder.

Conclusion: Small improvements in gait sway, TUG, and mCTSIB sway on noncompliant surfaces while wearing a maternity binder were found, which may indicate improved balance.


Effectiveness of Home-Based Physical Rehabilitation on Quality of Life in ICU Survivors: A Rapid Evidence Assessment 

Katherine Lucich, SPT; Kelsey Savio, SPT; Christian C. Evans, PT, PhD

Background: Survivors of serious illness such as patients with post-intensive care syndrome due to COVID-19 and Acute Respiratory Distress Syndrome often require extensive rehabilitation. Many of these patients receive home physical therapy (PT); however, the efficacy of post-intensive care unit (post-ICU) PT has not been well established.

Search terms: home rehabilitation AND critical illness; physical therapy AND critical illness; ((physical therapy) AND (critical illness)) AND (home health); (physiotherapy) AND (critical illness); (home health) AND (critical illness); physical therapy AND home program NOT Op; physical therapy AND critical illness; and physical therapy home program NOT outpatient.

Purpose: To determine whether home-based physical rehabilitation management improves quality of life for patients with post-ICU-acquired illness.

Methods: A Rapid Evidence Assessment was undertaken using the Cochrane Database of Systematic Reviews, Medline, PubMed, and SportDiscus. Inclusion criteria were: randomized control trials with subjects diagnosed with chronic or critical illness, 18 years or older, discharged from the hospital after an ICU unit stay, and underwent a physical rehabilitation program that primarily took place at home after discharge. Exclusion criteria were: patients that were in the hospital due to a musculoskeletal injury, were already part of a structured rehab program such as a stroke-specific rehab program, and patients less than 18 years old. Study quality was assessed using the PEDro scale. Primary outcome measures examining quality of life (QOL) included the Short Form-36 (SF-36) and Euroquol-5D (EQ-5D). Secondary outcomes included the Rivermead Mobility Index, 6 Meter Walk Test, and the Timed Up and Go to assess functional ability; and respiratory rate and dyspnea scale to measure respiratory function.

Results: A total of 1138 hits were reviewed, and five studies were selected for inclusion. The mean quality of the studies was 6 out of 10 and the range was from 5 to 7 on the PEDro scale. Length of programs ranged from four weeks to six months. Three out of the five studies were supervised directly by a physical therapist. Two studies found improvements in SF-36 score for the domain “role physical.” One study by Shelly et al. found improvements in SF-36 score for domains of “physical function,” “bodily pain,” and “general health.” Subgroup analysis found improvement in QOL in cardiorespiratory patients using the EQ-5D in the study by Vitacca et al. Other studies found improvements in secondary outcomes in the cognitive domain. However, overall QOL did not improve in any of the studies.

Conclusion: There is insufficient evidence found to support that home-based rehabilitation programs are effective in improving QOL for patients with post-ICU-acquired illness. Additional research is needed given the small number of studies and subjects included within this assessment. The inconclusive results may have been due to decreased intensity of the programs and decreased supervision of the subjects. Additional research is needed to determine if increased intensity and supervision help to improve QOL and other functional outcomes compared to outpatient rehabilitation services. This is particularly relevant given some survivors of COVID-19 have severe sequelae and need extensive rehabilitation in order to regain function. 


Exploration of US imaging for the Temporomandibular Joint 

Bre Reynolds PT, DPT, PhD, FAAOMPT; David Dominguese PhD, MS, ATC, CSCS; Brianna Heyer, SPT; Adam Wade, SPT; Alecsander Dutko, SPT; Melissa Adrian, Kelly Hernandez 

Background: While musculoskeletal ultrasound (US) imaging has been reported in research for the temporomandibular joint (TMJ), information is limited in scope and clinical implication, especially as it relates to physical therapy practice. Physical therapists utilize US for diagnosis of musculoskeletal pathology and real time US imaging examines muscle activity or biomechanics. There are little to no standard operating procedures for optimal visualization of TMJ anatomy or joint mechanics.

Purpose: Understanding the anatomical and biomechanical changes in the TMJ with various movements can inform decision making as physical therapists examine the TMJ and prescribe exercises. The purpose of this study is to add to existing literature regarding US settings for optimal visualization of the TMJ at rest and with motion in healthy subjects.

Methods: Four healthy subjects (age >18) were examined in this cross sectional descriptive study. Subjects were seated in an upright posture and researchers utilized the Terason™ uSmart 3200t ultrasound machine to examine the TMJ in multiple positions: rest, initiation of mouth opening, opening with the tongue on the palate, opening with retraction, and lateral excursion.

Results: Recruitment of participants was limited due to the impact of Covid-19. In the four participants examined, the best transducer position was parallel to the zygomatic arch allowing visualization throughout the range of motion. Some participants required the transducer to be held closer to the ear or with slight inferior/superior angulation along the face. A depth of 5 cm, frequency of 15 Hz, dynamic range of 63, and focal range of 2 were used for most images. Parameters were adjusted slightly for optimal visualization in each patient.

The image format was set as rectangular with omnibeam turned on. To improve visualization, the lights in the room were kept off. With each jaw position tested, participants returned to a resting position to re-establish the location of the mandibular condyle.

The mandibular condyle translated anteriorly as expected with opening and less anterior translation was noted with the tongue up. The retraction position before opening had the least amount of anterior translation. Movement of the condyle during lateral deviation was variable, however, a small amount of anterior translation of the contralateral condyle was noted. In some participants, the mandibular condyle moved so far anterior, it was out of view for the US transducer.

Conclusions: The US transducer position and parameters needed individual modification to obtain the clearest image of the TMJ. Anterior translation was visualized upon opening and less anterior translation was noted during opening with the tongue up and retraction before opening.