Standards for Tests and Measurements

Telehealth Opportunities in the Digital Age

If I Have Seen Further, It Is Because I Stand on the Shoulders of Giants

Change is everywhere: in health care, in education, in society. Change causes many emotions—excitement, discomfort, fear, exhilaration. In all cases, change brings opportunity. What we do with this opportunity is what determines the strength of who we are—as individuals, as physical therapists, as educators, and as an organization. A new CEO, a new manager, a new colleague, a new job, a new title, a new office—we have all experienced the discomfort that accompanies saying goodbye to the old and having to create the new without any guarantees. However, in many cases, these changes allow for growth, re-direction, and opportunities that may have been difficult had those changes not occurred. The Education Section, originally known as the Schools Section, is the oldest continuous section in the American Physical Therapy Association (APTA). It was made a permanent section in 1941 and is the only section not established under the aegis of the House of Delegates.1 In fact, at the time of the section's incorporation, APTA was still known as the American Physiotherapy Association. For many years, the Education Section has consisted of 4 distinct but overlapping member groups: special-interest groups (SIGs), the Academic Administrator SIG (AASIG), the Academic Faculty SIG (AFSIG), the Clinical Educator SIG (CESIG), and the Physical Therapist Assistant Educators SIG (PTAESIG). These groups have unique interests, concerns, and needs—all related to education. Historically, the leadership of the Education Section has been overwhelmingly composed of individuals involved in academic institutions. The focus of much of the business and most of the activities of the section has been on supporting academic issues as they impacted the classroom and the clinic. With the evolution of physical therapy education progressing to a doctor of physical therapy, the AASIG members determined that a different structure and organization was needed in order to accomplish their goals of providing educational leadership. The Academic Council, functioning under the APTA Board of Directors, was formed “to advance the enterprise of academic physical therapy by promoting the highest standards of excellence in academic programs.”2 During the Business Meeting of the Education Section at the Combined Sections Meeting (CSM) in February 2011, the membership voted to dissolve the AASIG. Throughout the development of the Academic Council, and under the assumption that AASIG issues would no longer drive its activities, the Education Section focused its attention on the opportunities and future goals for the section. The Executive Board of the section conducted a strategic planning session at CSM in February 2010 in San Diego. Enthusiasm was high and debates were lively as the future identity and purpose of the section were discussed. The result was a new brand, a new mission, and new goals that will inform the future activities and decisions of the section. The new brand is “Every PT and PTA is an educator.” Many of our guiding documents within APTA address our role as educators. The APTA Strategic Plan,3 adopted June 12, 2010, identifies education as a primary target area. The Code of Ethics for the Physical Therapist,4 Standards of Practice for Physical Therapy,5 and APTA's Guide for Conduct of the Physical Therapist Assistant6 address education as an obligation and commitment for the physical therapist and physical therapist assistant. Every clinician—no matter what the area of practice, level of expertise, or years of experience—spends more of his or her time educating others than on any other skill or activity. We educate our patients/clients, our colleagues, family members, students, caregivers, other health care providers, referral sources, third-party payers, legislators, attorneys—the list is endless. However, when we make decisions on how to spend our continuing education resources, improving our knowledge and strategies regarding our education skills may not seem that important. Why is that? Do you know the most effective and most evidence-based method of educating a teenager in how to manage her diabetes? Would the same teaching strategies be equally effective in educating her father or her grandmother? Is a lecture followed by a lab always the most effective way of educating your students in the classroom? Are group wellness programs more effective than one-on-one sessions? Are your educational materials, such as brochures, DVDs, and blogs—the preferred method of learning for your patient population? When designing your home exercise programs, is 3 enough? Is 6 too many? Are self-report logs reliable for determining compliance? What does the evidence say? These questions and many others helped the leadership of the Education Section to establish its new mission statement: To inspire all PTs and PTAs in their roles as educators and to enhance the development and implementation of evidence-based education practices. In order to meet this new mission, 3 major goals were developed for the section: 1. Standards of Practice: Provide support for the PT and PTA educator role by disseminating accessible resources on evidence-based teaching and learning principles, methods, and strategies. 2. Research: Promote scholarly activities and access to new knowledge that facilitates evidenced-based educational practices. 3. Education: Increase professional development opportunities to enhance the various educator roles in physical therapy practice. The first task that is currently underway to address our new goals is a grassroots needs assessment. Input that is derived from these informational focus groups across the country will be used to determine activities that will best meet the needs of the PT and PTA in their roles as educators. In addition, collaborative efforts are being explored between the Education Section and other sections to bring their combined expertise to educational presentations at national meetings. The development of special-interest groups (SIGs) has always stemmed from the need for networking among those who share similar personal and professional experiences, goals, and concerns. The purposes of the SIGs within the Education Section are to serve as a resource and forum for individuals, to facilitate networking and mentoring, and to share resources.7-9 Are there additional groups who seek such support? Is it time to develop an SIG within the Education Section for those who provide mentorship in postprofessional residency and fellowship programs? The atmosphere has been brisk at conference programming that addresses the differences between guiding and teaching students and mentoring postprofessional students. Rich discussions both locally and regionally suggest that there is a need for a residency and fellowship SIG. We need to cast a broader net. The term “educator” encompasses all of us, not just those teaching in higher education. Every PT and PTA educates someone, somewhere, every day, in every interaction that he or she has. Are we educating others in the most effective manner possible? Should we spend at least as much time honing our education skills as we do our manual skills? Education does not just occur in the classroom and the lab. It does not just occur when there is a PT or PTA student present in the clinic. It is not separate from our other professional obligations when we consider our responsibility to “promote optimal health and functioning in individuals by pursuing excellence in practice.”5 The newly established brand, mission, and goals cast a broad net for the Education Section. But the future of the section does not lie with the Executive Board. It is the members of the section who will determine its future. The members will decide if the new guiding documents and direction of the section reflect what they need to effectively assume their roles as professional physical therapists and physical therapist assistants. You, the members, will determine how the section will serve you. Make your voice heard. Participate in the needs assessment. Serve as an SIG officer. Talk with the Executive Board members. Volunteer your time and effort to ensure that your Education Section is what you need it to be. Change brings opportunity. Let's make the most of it.

Cecilia Graham, in the 2015 Cerasoli lecture, shared her passion for a new curricular model, the concept-based curriculum. Big ideas are the focus of this type of curriculum development and the instructional goal is to develop a deep understanding of these ideas in the learner by exploring linkages between the concepts and active learning.1 A big idea is certainly embodied in the vision statement for the physical therapy profession: “Transforming society by optimizing movement to improve the human experience.”2 This vision statement has been rapidly integrated into the organizational life of the American Physical Therapy Association (APTA). For example, APTA's Board of Directors has set its 3 major goals of transforming society, the profession, and the association. Many of the components are building plans and developing activities in a similar fashion. In addition to the vision statement, 8 guiding principles have been adopted to demonstrate how the profession will appear when this vision is enacted. One of those principles is “identity”: The physical therapy profession will define and promote the movement system as the foundation for optimizing movement to improve the health of society. Recognition and validation of the movement system is essential to understand the structure, function, and potential of the human body. The physical therapist will be responsible for evaluating and managing an individual's movement system across the lifespan to promote optimal development; diagnose impairments, activity limitations, and participation restrictions; and provide interventions targeted at preventing or ameliorating activity limitations and participation restrictions. The movement system is the core of physical therapist practice, education, and research.2 This principle has generated a great deal of conversation. For example, the APTA Board has adopted this definition of the movement system: “The human movement system comprises the anatomic structures and physiologic functions that interact to move the body or its component parts.”3 At the same time, the Board adopted the following statement on the specific role of the physical therapist relative to the human movement system.3 PHYSICAL THERAPIST PRACTICE AND THE MOVEMENT SYSTEM Human movement is a complex behavior within a specific context. Physical therapists provide a unique perspective on purposeful, precise, and efficient movement across the lifespan based upon the synthesis of their distinctive knowledge of the movement system and expertise in mobility and locomotion. Physical therapists examine and evaluate the movement system (including diagnosis and prognosis) to provide a customized and integrated plan of care to achieve the individual's goal-directed outcomes. Physical therapists maximize an individual's ability to engage with and respond to their environment using movement-related interventions to optimize functional capacity and performance. Read that again. We have defined a new system of the human body and stated that physical therapists bring a unique perspective to evaluation of this system and to movement-related interventions. Nordstrom used this concept to develop an Ignite Talk at the 2014 Geneva R. Johnson Innovations in Physical Therapy Education Forum. He postulated that this topic could become the universal accepted framework for physical therapist education curriculum.4 Graham also speaks to this, saying: We envision movement system experts who are leaders, innovators, collaborators, and entrepreneurs who can synthesize rapidly changing information, integrate advances in technology into practice, and have the flexibility to thrive in an evolving health care environment.5 This is indeed a big idea, one that can serve as the focus of our curricula, our research, and our practice. Do you understand the implications of defining a new body system on all that we do? How will you change what you teach, how you teach it, or how you organize your teaching? Are you prepared for this big idea?

Introduction.The purpose of this study was to 1) use the Clinical Teaching Effectiveness Questionnaire (CTEQ) to determine the self-perception of clinical teaching effectiveness (CTE) with a current sample of clinical instructors (CIs) and 2) determine if a relationship exists between CI characteristics and self-perceived ratings.Methods.A cross-sectional study was completed with a convenience sample of 194 physical therapists who served as CIs for 2 universities in the Northeast. Participants completed demographic data and the 30-item CTEQ, a valid and reliable tool, consisting of 4 sections with 8 subscales. Data were reported descriptively, and Mann–WhitneyUtests were completed to determine significant relationships between CI characteristics and the CTEQ subscales.Results.Overall, CIs agreed they were effective clinical teachers. Analysis revealed significant differences in scoring on the subscales of the CTEQ based on curricular model of the program from which the CI graduated, American Physical Therapy Association (APTA) membership, number of students supervised, APTA Advanced CI Credentialing, experience in a teaching role, highest degree earned, and Center Coordinator of Clinical Education role.Discussion and Conclusion.The CTEQ provides a preliminary valid measure for assessing CTE in physical therapy practice. Multiple factors were discovered to have an influence on CI's self-perception of clinical teaching using the CTEQ. Notably, the long-term impact of problem-based learning curricula were associated with identification of student learning domains and total score on the CTEQ, adding new information regarding curricular influence on CIs' self-perception of CTE. The CTEQ can be used by academic programs and clinical sites to develop strategies to better prepare CIs delivery of high-quality clinical education experiences.

BackgroundA primary barrier to the implementation of evidence based practice (EBP) in physical therapy is therapists’ limited ability to understand and interpret statistics. Physical therapists demonstrate limited skills and report low self-efficacy for interpreting results of statistical procedures. While standards for physical therapist education include statistics, little empirical evidence is available to inform what should constitute such curricula. The purpose of this study was to conduct a census of the statistical terms and study designs used in physical therapy literature and to use the results to make recommendations for curricular development in physical therapist education.MethodsWe conducted a bibliometric analysis of 14 peer-reviewed journals associated with the American Physical Therapy Association over 12 months (Oct 2011-Sept 2012). Trained raters recorded every statistical term appearing in identified systematic reviews, primary research reports, and case series and case reports. Investigator-reported study design was also recorded. Terms representing the same statistical test or concept were combined into a single, representative term. Cumulative percentage was used to identify the most common representative statistical terms. Common representative terms were organized into eight categories to inform curricular design.ResultsOf 485 articles reviewed, 391 met the inclusion criteria. These 391 articles used 532 different terms which were combined into 321 representative terms; 13.1 (sd = 8.0) terms per article. Eighty-one representative terms constituted 90 % of all representative term occurrences. Of the remaining 240 representative terms, 105 (44 %) were used in only one article. The most common study design was prospective cohort (32.5 %).ConclusionsPhysical therapy literature contains a large number of statistical terms and concepts for readers to navigate. However, in the year sampled, 81 representative terms accounted for 90 % of all occurrences. These “common representative terms” can be used to inform curricula to promote physical therapists’ skills, competency, and confidence in interpreting statistics in their professional literature. We make specific recommendations for curriculum development informed by our findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0641-1) contains supplementary material, which is available to authorized users.

In recent years, the use of diagnostic imaging in physical therapist practice in the United States has gained considerable interest. In several countries around the world and in the US military, patient direct referral for diagnostic imaging has been considered normative practice for decades. US physical therapy program accreditation standards now stipulate that diagnostic imaging content must be included in physical therapist educational curricula. The American Physical Therapy Association has made efforts to pursue practice authority for imaging referral. A recent review of state practice acts and other statutory language concluded that many states have no prohibitions against physical therapists referring for imaging studies. Additionally, physical therapists can now pursue certification as musculoskeletal sonographers. In light of these advances, and with a growing number of physical therapists serving patients who have not yet seen another health care provider, it may be helpful for those who have been actively involved in the use of imaging in physical therapist practice to provide their collective recommendations to serve as a guideline to those interested in incorporating this practice privilege. The purpose of this perspective article is to provide an overview of the key elements necessary for effective implementation of referral for imaging in physical therapist practice while emphasizing the cornerstone of effective communication.

Background and Purpose. Since its inception in 1993, professional (entry-level) Doctor of Physical Therapy (DPT) degree has been adopted by a rapidly growing number of programs in United States. The purpose of this study was to provide information on process and status of transition toward DPT in spring 2003, updating and extending a previous study completed in spring 2000. Subjects. Directors of 145 of 191 (76%) accredited physical therapist education programs participated. Method. An Internet-based questionnaire was sent to directors of 191 accredited physical therapist education programs in United States. Results. Of 144 respondents, 119 had made a decision regarding DPT, with 117 of those (98%) deciding in favor of offering DPT degree. Compared to public institutions, a higher proportion of programs at private institutions had decided to implement DPT. Substantially more programs were further along in higher-level approval process than in 2000. Desired characteristics of DPT students at entry were relatively unchanged compared to those desired by programs previously in place at respective institutions. According to questionnaire responses, clinical education characteristics have changed to include: more hours in clinical education, longer duration of each clinical experience, and facilitation of student roles beyond patient care. Almost 90% of DPT programs required either a group or individual culminating scholarly project. Programs' desired faculty characteristics have evolved and put a greater emphasis on a record of publication, establishment of a research agenda, and possession of a doctoral degree other than professional (entry-level) DPT. Discussion and Conclusion. Programs educating physical therapists in United States are transitioning to professional DPT programs at a rate that exceeds prior predictions. While there are still a higher proportion of programs at private than public institutions making transition, other characteristics that once differentiated programs with differing decisions are no longer factors. Key Words: Doctor of Physical Therapy degree, Physical therapist education. BACKGROUND AND PURPOSE Professional (entry-level) education for physical therapists in United States is rapidly changing to Doctor of Physical Therapy (DPT) degree. Initially discussed by Johnson in her Mary McMillan lecture to American Physical Therapy Association (APTA) in 1985,' first professional DPT class was initiated at Creighton University in 1993.2 Barely more than a decade later, Evaluative Criteria adopted by Commission on Accreditation in Physical Therapy Education (CAPTE) indicated that DPT degree was preferred degree to be awarded for completion of a professional physical therapist education program.' The DPT degree is thought to match length and complexity of contemporary physical therapist education as well as provide appropriate preparation for clinical decision-making and diagnostic skills required within contemporary physical therapist practice. The transition to DPT degree has been moving at a pace that is difficult for refereed literature of profession to match. A study conducted by Task Force on Entry-Level Doctoral Education of APTA's Education section was undertaken in spring 2000 and published in 2002. This study, though dated by time of publication, provided insight into process of transition to DPT degree among accredited physical therapist education programs at institutions in United States, and predicted that up to 58 entry-level doctoral programs will exist by 2005.4(p65) However, even in 2000, these authors acknowledged volatile nature of education and practice environments(p61) and anticipated that the nature and pace of transition may undergo substantial change as it unfolds over next several years. …

This is such an incredible honor. I want to thank all of my colleagues who were involved in the nomination process, with a special thank you to Dr David Morris, who coordinated the nomination packet. I also want to thank the Education Section Awards Committee for selecting me for this honor, and Pauline Cerasoli's family members, who were instrumental in designating funds for this lecture. Finally, I want to recognize all of the previous Cerasoli lecturers for their inspiring thoughts about physical therapy education.Although I didn't know Polly well, I had the honor of interacting with her on 2 occasions. We were first introduced by a mutual acquaintance at a reception at a conference in the late 1980s. A year or so later, on a connecting flight on the way to yet another conference, I happened to be seated across the aisle from Polly. We recognized each other and chatted off and on throughout the flight. My perceptions of Polly, based on these interactions, were that she was warm, greeting me with a bright smile and a gracious manner even though we had only met once before; witty, displaying a wry sense of humor that I could relate to; and wise, with insightful observations about professional issues we discussed. As a tribute to Polly, I will do my best to try to reflect those qualities-warmth, wit, and wisdom-in my remarks today.INTRODUCTIONThis is an exciting time for the profession of physical therapy. There has been lively dialogue about the future of physical therapy practice and education, beginning with the Physical Therapy and Society Summit (PASS)1 and continuing with an Innovation Summit on Collaborative Care Models,2 the networking conference, Preparing the Next Generation of Physical Therapists for Innovative Practice,3 and a Clinical Education Summit4 in 2014. In addition, the American Physical Therapy Association (APTA) adopted a far-reaching vision statement in 2013: Transforming society by optimizing movement to improve the human experience.5As a result of these initiatives, a picture of the physical therapist of the future is emerging. We envision movement system experts who are leaders, innovators, collaborators, and entrepreneurs who can synthesize rapidly changing information, integrate advances in technology into practice, and have the flexibility to thrive in an evolving health care environment. That vision creates an exciting but challenging opportunity for educators, as we develop academic and clinical learning experiences to prepare future physical therapists. As I considered the vision for the future of physical therapy and reflected on a topic for this lecture, I decided that the timing was right to begin some dialogue about future curricular models for physical therapist education.My objectives for this presentation are that learners will be able to identify factors affecting the need for revision of current curricular models, describe principles of concept-based curricular models, and analyze potential opportunities and challenges for implementation of a concept-based curriculum model.My overarching goal is to stimulate thought and discussion about the type of curricular models that will be a good fit for the future needs of the profession and of society.The Spiral of LearningIt will come as no surprise to anyone who has worked with me or taken a course with me that I am beginning this session with the spiral of learning (Figure 1). Constructivist Learning Theory holds that we each have a unique spiral of learning in which our previous knowledge, beliefs, bias, and experiences are swirling around.6 When new knowledge enters the spiral, 1 of 2 things can happen. The new knowledge can either be integrated with previous knowledge or experiences or it can squirt out the sides of the spiral of learning. The key to minimizing squirtage, if you will, is relevance. The more relevant the information, the more likely it is to be assimilated into the spiral of learning. …

Background and Purpose. Pro bono physical therapy services have become an integral aspect of community service due to recent changes in health care reimbursement limitations. Physical therapist educators are expected to introduce their students to the concept of social responsibility and human service activities. Model Description and Evaluation. pro bono clinic was designed to meet critical needs of the physical therapist students at our academic institution, as well as patients within the community. This clinic introduced the students to patients and the roles and responsibilities of patient care prior to their first clinical educational experience, which helped to relieve anxiety, promote professional socialization, and enhance retention of learned materials. Students participated in a mock clinic within the pro bono setting where they assumed the roles of patient, physical therapist, and peer evaluator. Within this mock clinic, students were required to present assigned patient diagnoses in a grand rounds formal, which helped to reinforce didactic knowledge and enhance verbal and written communication. Outcomes and Discussion. Students gained exposure to the clinical setting itself, experienced the patient-physical therapist relationship, and interacted with their peers and faculty members. The patients not only received treatment without cost, but they benefited from the time with the students as they educated them on their pathologies and functional limitations. Faculty benefited from becoming role models the students, improving relations and communication with the students, and observing and mentoring the students in a small group setting. Conclusion. Limitations implementation of this clinic were minimal. It is anticipated that this unique model will enhance students' clinical performance, provide faculty with clinical practice opportunities, and fulfill the health care needs of the community. Key Words: Pro bono, Mock clinic, Faculty-student clinic. BACKGROUND AND PURPOSE Due to recent changes in the health care system, many individuals are unable to afford adequate insurance coverage. This has affected individuals of all ages, especially those self-employed and unemployed. Those employed utilizing managed health care have seen a reduction in the types and numbers of reimbursed services. Within physical therapy, this reduction in the number of allowable visits has held the patient accountable financially, when and if they want to extend the length of their nonreimbursable treatment. For those patients with chronic conditions, health care coverage is inadequate to address their long-term needs.1,2 These needs, both rehabilitative and preventative, can be addressed through pro bono services. Pro bono publico (Latin for the public good) service is an age-old concept under which goods or services are given at a small fee or free of charge to those who cannot afford them.3 This provision of free services is strongly supported in the legal and health care professions. The American Physical Therapy Association (APTA) Code of Ethics, Principle 10, states A physical therapist shall endeavor to address the health needs of society,4 while the APTA Guide Professional Conduct, Principle 10.1, states, A physical therapist shall render pro bono publico (reduced or no-fee) services to patients lacking the ability to pay services, as each physical therapist's practice permits.5 Changes within the health care system have also affected the environment within physical therapy clinics. The current increased pace within the clinical facilities requires the novice physical therapist (PT) practitioner to be adaptable and flexible to accommodate to the fluctuating clinical demands. Because of the expansion in physical therapy scope and domain of practice, the traditional organizational box that defined who PTs are, what they do, and where they practice has been altered. …

Edelle (Edee) Field-Fote, PT, PhD, FASIA, FAPTA, the 54th Mary McMillan lecturer, is director of the Shepherd Center Spinal Cord Injury Research Program & Hulse Laboratory; professor in the division of physical therapy at Emory University School of Medicine; and professor of the practice in the school of biological sciences at the Georgia Institute of Technology. In her role as the director of spinal cord injury (SCI) research at Shepherd Center, Field-Fote leads a team dedicated to improving motor function in people with SCI through the development of neuromodulation and neurorehabilitation approaches informed by the latest neuroscience research and guided by outcomes that have meaning for people with SCI. With a clinical background as a physical therapist, PhD training in a preclinical model of SCI, and postdoctoral training in motor control physiology, her 25-plus years of SCI research have spanned the breadth of basic and clinical/translational research related to SCI. Dr Field-Fote has conducted randomized clinical trials with funding from the National Institutes of Health since 1997; other clinical trials in her lab have been funded by the Department of Defense, the National Institute on Disability Independent Living and Rehabilitation Research, and numerous foundations. Field-Fote is the recipient of multiple honors from the American Physical Therapy Association (APTA) and its components. She is a Fellow of APTA and a Fellow of the American Spinal Injury Association. She has also served in numerous APTA and APTA component appointed or elected positions and as a member and president of the Foundation for Physical Therapy Research Board of Trustees.

For healthcare providers involved in the management of patients with musculoskeletal disorders, the ability to order diagnostic imaging is a beneficial adjunct to screening for medical referral and differential diagnosis. A trial of conservative treatment, such as physical therapy, is often recommended prior to the use of imaging in many treatment guidelines for the management of musculoskeletal conditions. In the United States, physical therapists are becoming more autonomous and can practice some degree of direct access in 48 states and Washington, DC. Referral for imaging privileges could increase the effectiveness and efficiency of healthcare delivery, particularly in combination with direct access management. This clinical commentary proposes that, given the American Physical Therapy Association's goal to have physical therapists as primary care musculoskeletal specialists of choice, it would be beneficial for physical therapists to have imaging privileges in their practice. The purpose of this commentary is 3-fold: (1) to make a case for the use of imaging privileges by physical therapists, using a historical perspective; (2) to discuss the barriers preventing physical therapists from having this privilege; and (3) to offer suggestions on strategies and guidelines to facilitate the appropriate inclusion of referral for imaging privileges in physical therapist practice. J Orthop Sports Phys Ther 2011;41(11):829-837. doi:10.2519/jospt.2011.3556.

Introduction Culture has been defined as: “a tradition of knowledge and practice that is shared, albeit imperfectly, across the members of a society and across its generations” [Zou et al 2009]. It shapes people's experiences and their emotional reactions [Gard et al 2005], including their understandings of what it means to be healthy, the meanings of symptoms, attitudes towards disability and treatment, and coping strategies [Dean et al 2006; Gallaher et al 2001]. The study suggested here may offer new insights by exploring how culture shapes the experience of stroke care through the perceptions of Physical therapists working in the state of Qatar. Qatar is one of the wealthiest countries in the world. The culture reveals the modernising influences associated with oil exploration and technological advances whilst preserving collective traditions. The state provides extensive financial support for its own citizens including generous pensions and access to health care. However, in common with other Gulf st...

Background: Pelvic health physical therapists (PTs) use a variety of treatment approaches to treat overactive bladder (OAB). Transcutaneous tibial nerve stimulation (TTNS) uses peripheral neuromodulation to deliver electrical current to the tibial nerve for the treatment of OAB. The purpose of this survey was to identify current practice patterns and barriers to implementation of TTNS. Methods: One hundred and seventy-eight surveys were electronically submitted by PT members of American Physical Therapy Association (APTA) Academy of Pelvic Health Physical Therapy (APHPT). Results: The use of TTNS by pelvic health PTs in the United States (US) varies widely. Only 30.6% of therapists noted using TTNS as first line therapy along with behavioral and lifestyle modifications. The most common reasons therapists do not use TTNS include precautions or contraindications and patient choice. Some therapists reported unfamiliarity with the research as a reason for not using TTNS. A significant association was found between a PT not being familiar with the research and how often TTNS was used ( P = .0111). The majority of therapists in this survey position electrodes on a single limb and used a pulse width of 200 or 250 microseconds (µsec), and a pulse frequency of 10 to 12 hertz (Hz) for 30 minutes. This aligns with current evidence. Discussion: TTNS should be considered in a pelvic PT treatment algorithm for OAB. Evidence suggests that providers increase their knowledge of TTNS and educators include instruction about TTNS in evidenced-based training in order to apply the modality effectively.

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT.