Background and Purpose: Patients with end-stage renal disease require hemodialysis (HD), often leading to prolonged sedentary periods and missed physical and occupational therapy sessions during hospitalizations. Intradialytic exercise (IDE) – incorporation of exercise programs during hemodialysis sessions – has been shown to improve dialysis adequacy, cardiovascular fitness, muscle strength, and quality of life in the outpatient setting. IDE is widely studied in outpatient care, however this paper introduces a novel acute program implemented at a large, urban, academic medical center. This program was designed to enhance patient access to therapy services during hospitalizations and to demonstrate the feasibility and safety of IDE in the acute care setting. Approach: The Define, Measure, Analyze, Improve, and Control (DMAIC) methodology was utilized to effectively implement IDE in the acute care setting. Quantitative data identified the clinical nursing units with the highest prevalence of patients on dialysis, which determined the pilot units selected for IDE. Clinical guidelines, exclusion criteria, and a competency specific to IDE were developed and utilized to train physical and occupational therapists to perform IDE. Outcomes: Implementing IDE decreased the percentage of missed therapy sessions by 15%. Discussion and Conclusion: This study demonstrates that IDE is feasible and safe in the acute care setting. It is largely based on evidence from the outpatient setting, which demonstrates the safety, feasibility and positive impact of IDE on patient outcomes. Utilizing a competency and clinical guidelines, specifically for IDE, paired with educational sessions and in-person observation is an effective way to train therapists to perform IDE. IDE reduces the number of missed therapy sessions, allowing patients on dialysis increased access to therapy services while hospitalized. There is an opportunity to evaluate the impact of IDE on patient-specific outcomes in the acute care setting in the future.

Introduction: The Academy of Acute Care Physical Therapy released the “Core Competencies for Entry-Level Practice in Acute Care Physical Therapy” (CC-ACPT) in 2015. There have been no known published studies investigating the incorporation of these core competencies into doctor of physical therapy (DPT) educational programs throughout the US. Methods: A survey instrument was developed, reviewed by experts, revised, and disbursed by email to faculty extracted from accredited DPT program websites. The survey queried the inclusion of the CC-ACPT, other curricular topics, the manner and method acute care curriculum is constructed, and faculty perceptions of the level of importance of core competencies domains and objectives as they pertain to education and entry-level practice. Results: Across the 5 domains of the core competencies, 10 of the 41 objectives are not included in >85% of respondents’ curricula. Responding academicians rated discharge planning as the least important and having the least confidence regarding curricular inclusion among the core competency domains. Among curricular content surveyed beyond the core competencies, specialized tests, especially pertaining to the intensive care unit, were least likely to be included. Discussion/Conclusion: As the first-known survey of acute care physical therapy curriculum, findings demonstrate that there are elements of the core competencies, published in 2015, that are still not well integrated into entry-level DPT programs. Identifying content excluded from curricula and ways to ensure dissemination of the upcoming revised essential competencies will be critical in ensuring knowledge translation, which will impact future entry-level practice.

Purpose: Acute care physical therapy (PT) is a rapidly evolving area of practice. To ensure continuity and consistency of care and advance the science effectively, communication between clinicians, researchers, and academicians is essential. This can occur in the form of literature. Unfortunately, barriers limit dissemination, integration, and progression of literature to all interested parties. The purpose of this article is to highlight selected acute care PT literature published in 2023 to share current knowledge amongst all members of the acute care PT community. Methods: Acute care PT literature from the year 2023 was searched for and reviewed. Articles for presentation were selected based on relevance to today’s health care environment, hot topics, and the anticipated future of acute care PT. Results: Articles were stratified into value-based care, clinical practice including differential diagnoses and treatment dosage, and entry level Doctor of PT didactic and clinical education. Following the summary of each topic’s articles, clinical relevance and future directions are discussed. Conclusions: Evidence supports the importance of intra-professional collaboration. The acute care PT community must work together to further demonstrate our value in a rapidly changing health care environment, optimize patient outcomes through progressive interventions and rigorous outcome measures, and implement novel techniques to educate the next generation of physical therapists.

Introduction: Cauda equina syndrome (CES) is a serious medical condition affecting the lumbosacral spine that requires emergent surgical intervention to relieve symptoms and prevent lasting neurological deficits. Previous studies have shown discharge location after CES surgery may have been associated with increased complications and poor outcomes. The purpose of this study is to evaluate factors associated with home or nonhome discharge after surgery for CES to assist with appropriate discharge planning by the medical interdisciplinary team. Review of Literature: Little data exist regarding factors associated with discharge location after surgery for CES. Subjects: One hundred fourteen patients who had surgery for CES in a hospital setting. Methods: This study is a retrospective case control study. Surgery for CES was performed by both orthopedic surgeons and neurosurgeons. Main outcome measure was discharge to home (n = 61) or a nonhome location (n = 53). Data recorded include age, gender, type of surgery performed, preoperative symptoms, postoperative symptoms, and level of participation in physical therapy in the hospital. Statistical analysis included logistic regression with odds ratio (OR) and 95% confidence intervals (CI). Results: Total patients (n = 114) had a mean age of 55.4 ± 18.1 years with 52.6% being male. Some factors associated with home discharge after surgery for CES via univariate analysis included no preoperative bowel/bladder symptoms (OR = 3.12; 95% CI = 1.19-8.19; P = .02), higher preoperative motor score (OR = 2.40; 95% CI = 1.40-4.12; P = .002), increased postoperative motor score (OR = 3.67; 95% CI = 1.62-8.30; P = .002), increased first distance walked (OR = 1.06; 95%CI = 1.02-1.09; P = .002), and increased total distance walked over LOS (OR = 1.01; 95%CI = 1.00-1.01; P = .0001). Multivariate analysis showed that decreased total distance walked during acute care hospital admission was associated with nonhome discharge (P < .02). Discussion and Conclusion: There are various factors associated with particular discharge locations after CES surgery, such length of hospital stay, preoperative bowel and bladder function, extremity strength scores, and ability to ambulate after surgery with physical therapy. As discharge location may impact patient outcomes, it is important identify which rehabilitation factors may be associated with patient discharge location after surgery for CES.

Background and Purpose: The purpose of this basic interpretive qualitative study was to explore physical therapist faculty members’ perceptions of barriers related to teaching with high fidelity simulation (HFS) manikins within the Doctor of Physical Therapy (DPT) curriculum. Case Description: Eight physical therapist faculty members with no experience teaching with HFS manikins participated in semi-structured one-on-one interviews to understand their perceptions of barriers to this type of HFS as a teaching methodology within the DPT curriculum. Outcomes: Three overarching themes arose through qualitative analysis, which describe participants’ perceptions. Major themes were: (1) HFS manikins are unnecessary to achieve course objectives; (2) HFS manikins are not human; and (3) Teaching with HFS manikins may not be worth the effort. Discussion and Conclusion: The findings of this study can assist DPT programs, faculty, and Program Directors consider including HFS manikins into the curriculum by increasing awareness of potential barriers among those individuals who have not taught with HFS manikins. Further research is warranted to continue to explore the evolving role this technology has in the DPT curriculum.

Introduction: Physical therapists assist with discharge planning for hospitalized patients by making recommendations regarding a patient’s optimal discharge location and ongoing rehabilitation needs. The purpose of this study was to examine the consistency of discharge recommendations made by physical therapists with experience working in an acute care setting, when provided with a set of clinical vignettes describing hospitalized patients. Review of Literature: Considering the complex/multifactorial nature of making discharge recommendations, one would expect there to be inconsistencies among physical therapists. However, we are not aware of a previous study examining the level of consistency for discharge recommendations made by physical therapists, when reviewing a set of clinical vignettes. Subjects: Nineteen physical therapists working in an acute care setting. Methods: The physical therapists were provided with 10 clinical vignettes describing hospitalized patients via an electronic survey distributed across three rehabilitation departments. Each vignette described the patient’s medical condition, past medical history, prior level of function, living situation, key examination findings, and other general characteristics. After independently reviewing each case, the physical therapists selected a discharge recommendation from a list of standard options. Fleiss’ kappa was examined to assess the level of agreement among the physical therapists. Results: Overall, Fleiss’ kappa was 0.28, which reflects fair agreement among the physical therapists. Discussion and Conclusion: The 19 physical therapists who participated in this study only exhibited fair agreement with respect to their discharge recommendations. This relatively low level of agreement suggests that efforts to improve the consistency of discharge recommendations should be explored.

Purpose: To explore the perceptions and experiences of acute care pediatric physical therapists (PTs) regarding the use of patient-reported outcome measures (PROMs) and to understand the influence of PROMs on clinical decision-making and the plan of care. Methods: Thirteen acute care pediatric PTs participated in individual semistructured interviews using a qualitative phenomenological approach. Interview questions focused on how PROMs influence clinical practice and decision-making. Interviews also explored scenarios where using PROMs positively or negatively impacted patient and caregiver interactions. Researchers analyzed the interview transcripts using an inductive process to generate codes and resultant themes. Results: Participants described their experiences using PROMs in pediatric acute care, and 4 themes emerged: (1) PROMs can be difficult to implement in pediatric acute care, (2) PROMs can benefit pediatric acute care practice, (3) PROMs can improve service delivery and family-centered care, and (4) ideal PROM use in future practice. The Theoretical Domains Framework (TDF) was used to categorize positive and negative factors related to implementing evidence-based guidelines in the pediatric acute care setting. Conclusions: Acute care pediatric PTs report benefits and barriers to using PROMs with children and caregivers in the hospital setting. Findings support the need for future knowledge translation initiatives to facilitate the use of PROMs in pediatric acute care.

During the recent 2023 APTA Acute Care Lecture Award presentation, "Ongoing Lessons from the Global Pandemic, Telehealth, DEI, and Pursuit of Excellence," a charge to action was made. The presenter, Alan Lee, PT, PhD, DPT, spoke about the importance of mentorship and support, as it related to careers in physical therapy. During this Combined Sections Meeting (CSM) presentation, Dr Lee alluded to the Academy's new strategic plan, and he challenged all of us to become engaged, to mentor, to pursue excellence, and utilize evidence-based resources in our practice. How will our Academy rise to that charge? Does our strategic plan align with those objectives? Admittedly, my biased response is yes. The APTA Acute Care aspiration statement projects that "on January 1, 2026, APTA Acute Care is an innovative, engaged, and diverse community that has elevated acute care practice and advanced early career PTs and PTAs. APTA Acute Care is known as the leader and go-to resource for acute care practice."1 To get there we will need to focus our efforts in 3 pillars: sustainable profession, member value, and quality of care. See the information below for the definitions of each pillar and follow this link to the APTA Acute Care Strategic Framework (https://www.aptaacutecare.org/page/strategicplan): Sustainable profession. Develop a compelling value proposition and supporting offerings for students and early career professions to join the association and profession. Member value. Deliver meaningful opportunities to belong, engage, and contribute. Quality of care. Elevate acute care practice to improve health outcomes for populations, communities, and individuals. As part of our commitment to a sustainable profession, we must grow our base of students and early professionals. Physical therapists and physical therapist assistants need to fall in love with acute care, early in their career. Many of us have had experiences with students who began their acute care clinical rotations determined to seek careers in outpatient, only to have an epiphany and realize that acute care physical therapy was the skilled area of practice they wanted to work in. How can we create those moments of excitement and deeper understanding of acute care physical therapy practice on a larger scale? One strategy is to offer free membership to students of physical therapist assistant or physical therapist programs the opportunity to experience the academy, to use the available resources during their clinicals, to create opportunities for them to engage with other members, to provide opportunities to serve on committees, and to contribute to the work of the Academy. The Academy currently has highly engaged students involved in authoring post-CSM Critical Edgemail submissions, serving on communication subcommittees, contributing to podcasts, and serving as academy representatives on the APTA student council. We anticipate that a new student taskforce may also provide additional insight on how to engage, support, and mentor this group. As a national organization, how can the Academy stay connected and support our members? As part of our commitment to deliver member value, the Academy will soon launch an acute care state advocate program. It is anticipated that this program will provide a meaningful way for more members to belong, engage, and contribute with other committed acute care therapists in their state. For quality of care, the Academy is planning several exciting initiatives. Innovative work is being developed by the Research Committee including ongoing CSM research connection events. There will be additional clinical practice guideline projects. The Practice Committee continues to create valuable resources and has plans for a clinician toolkit. Furthermore, members will note several knowledge translation initiatives that will complement the Academy's efforts toward the pillar to elevate quality of care. The bottom line, in order for the Academy's strategic plan to be successful, and for us as clinicians to answer Dr Lee's charge, we need you. We need for all of our members to engage and contribute to the work of the Academy. For those who have hesitated to volunteer for Academy service, I ask you to step forward. I believe in a quote by Malcolm Forbes, "Too many people overvalue what they are not and undervalue what they are."2 I guarantee that our Academy will benefit from your contributions. There are many ways you can support the Academy and the acute care profession. Your contributions could include posting on the listserv, serving on committees or taskforces, attendance at educational sessions, Bridge the Gap and CSMs, becoming involved in professional advocacy, participation in surveys, polls, and elections, conducting research, submissions to the Journal of Acute Care Physical Therapy, participation in knowledge translation activities, including journal clubs, as well as being involved in mentorship of acute care students, residents, and colleagues.3 Yogi Berra once stated, "Little things make a big difference."4 I look forward to partner with you, as we pursue the Academy's strategic plan to support our members and pursue excellence. Respectfully, Traci L. Norris, PT, DPT President

Background: The physical therapist's (PT's) role on the interprofessional team is specialized to address a patient's functional needs. Statement of the Problem: Functional status is a key determinant for rehospitalization and is associated with the greatest risk of readmission, yet typical discharge planning teams do not include the PT as an integral member of the team. When PTs are involved, the likelihood of rehospitalization is much lower. The PT has an essential role in the discharge process to align the patient's capacity with the community resources that will best achieve a safe transition plan, facilitate restoration of functioning, and achieve an optimal outcome. Impact Statement: PTs are essential members of the care transitions team and improve patient outcomes across the health care system. This perspective highlights a critical nontraditional role for PTs to fill that will help improve health care decision-making and reduce the risk for rehospitalization and adverse health outcomes.