Showing papers in "The Internet Journal of Allied Health Sciences & Practice in 2007"

Functional Balance Assessment of Older Community Dwelling Adults: A Systematic Review of the Literature

Abstract: Background: For allied health professionals wishing to assess the functional balance of older adults living in the community, the vast number of functional balance tests available makes it difficult to decide which assessment is most appropriate. Objective: To identify the reliability, concurrent validity and clinical practicality of functional balance tests with community dwelling older adults. Methods: A systematic review of published literature relevant to 17 functional balance tests was undertaken. The 17 functional balance tests were identified by a preliminary literature search and through consultation with an expert in the field of functional balance assessment. Studies published in English before January 2007, assessing the use of these functional balance tests with community dwelling adults aged 65 years or above were included. The CINAHL, MEDLINE, Ageline, Amed, PubMed, Cochrane library, PEDro and Joanna Briggs Institute databases were searched. The methodological quality of studies was assessed using a checklist criteria adapted from the Cochrane Working Group for Screening and Diagnostic Tests. Results: Eight databases were searched and 21 studies were included. The majority of studies demonstrated low to moderate methodological quality scores. Despite limitations reported for clinical application with community dwelling older adults, the Berg Balance Scale and the Timed Up and Go Test have been most rigorously tested. Reliability and concurrent validity of the Balance Screening Tool and the Fullerton Advanced Balance Scale had also been established in this population, however only one study was retrieved for each. Conclusion: The Berg Balance Scale and Timed Up and Go Test have published reliability and validity with community dwelling older adults. Further testing of other functional balance tests is required to establish their reliability and validity in this target population. BACKGROUND

Intervention for Children with Developmental Coordination Disorder: A Systematic Review

Abstract: Prevalence of children with developmental coordination disorder (DCD) is high (6-13% of all school children) and the negative impact of their movement difficulties on their participation in recreation and academic pursuits is well documented. This secondary research systematically reviewed the available literature for evidence of effectiveness of interventions that aim to improve the movement capability of children with DCD. Specified databases were searched for appropriate studies, these were retrieved and two reviewers appraised the level and quality of evidence. Thirty one studies were included between levels I and III-3 of the NH & MRC protocol. Scoring using an established critical appraisal tool demonstrated variable quality. Meta-analysis was not possible due to the clinical heterogeneity of the primary studies. A best evidence synthesis of results was conducted, producing clear evidence that no intervention has poor results when compared to any intervention. The high number of purportedly different interventions and variable quality make definitive conclusions about the merits of specific approaches difficult. There may be generic qualities or factors in the studied interventions that are more important for effectiveness than specific content. More information is needed on the underlying mechanisms of DCD, factors influencing effectiveness and the broader pragmatics of intervention delivery.

'It's All Part of the Package' in Rural Allied Health Work: A Pilot Study of Rewards and Barriers in Rural Pharmacy and Social Work

Abstract: Objective: The objective of this pilot study was to identify personal and professional factors that influence health workers’ commitment to remaining in rural and remote areas with the aim of identifying research directions for a larger study and informing workforce recruitment and retention strategies. Design: Accidental sampling then qualitative interviews with pharmacists and social workers. Setting: Six rural communities with populations less than 5,000 in New South Wales, Australia. Methodology: Deductive and inductive analysis of data. Results: Common rewards included the value attached to pharmacists’ and social workers’ contributions to rural communities, ability to assist people to solve problems, and accessibility. Common barriers included lack of peer support, inability to attend professional development, and inadequate social and cultural facilities. The key factor mediating personal and professional experiences was a perception of community connectedness. Personal and professional issues are interrelated. Social workers in the public health system are more likely to change jobs than community pharmacists. Conclusion: Social workers and pharmacists appear to experience similar rewards and barriers in their professional and personal lives when compared to other rural health workers, including general practitioners, all of which are mediated by the degree to which they are connected to their community. Rewards and barriers in personal and professional life exist on an interrelated continuum that has to be balanced to manage a high degree of visibility experienced by health workers in small rural communities. Implications: The need for a systematic evaluation of workforce retention strategies is highlighted. New practitioners require skills in managing the connections between personal and professional life rather than viewing them as separate. Further work is required into the implications of life stage on decisions about work location.

Job Satisfaction among Practicing Pharmacists: A Rasch Analysis

Abstract: Purpose: through the application of a Rasch rating scale model, the researchers investigated the effect of gender, ethnicity, practice site, income, and age on levels of job satisfaction among practicing pharmacists. Method: The data consist of responses to a survey questionnaire mailed to a random sample of 5,000 registered pharmacists throughout the United States. A total of 820 individuals mailed back their completed form for a response rate of 16.4 percent. Results: Older, higher-wage earning pharmacists working at independent practice sites experience the greatest amount of job satisfaction. Conclusion: The most significant finding from this study is that age, income, and practice site can predict job satisfaction among practicing pharmacists. Additionally, the results provide empirical evidence for the variables inclusion in future models and they demonstrate the usefulness of Rasch techniques.

Sleep Position, Age, Gender, Sleep Quality and Waking Cervico-Thoracic Symptoms

Abstract: Purpose: An epidemiological study was undertaken to investigate the association between sleep position, age, gender, sleep quality and prevalence of waking cervical pain and stiffness, headache and aching between the scapulae and/or in the arm. Method: A randomly administered telephone survey was completed by 76% of prospective participants, yielding 812 completed surveys. Results: This study confirmed that the majority of subjects sleep in the side lying position and that this sleep position significantly protected against waking cervical, scapular and arm pain and significantly promoted high sleep quality ratings. Anecdotally, supine sleep position has been recommended for the prevention of cervical symptoms however, this study identified no advantage in adopting the supine sleep position in relation to the prevalence of waking symptoms. The adoption of an upright sleep position was significantly associated with increased prevalence of all waking symptom categories and low sleep quality ratings. These findings were of greater significance in the presence of medication use, or a medical condition which affected sleep quality. Prone sleep position was not significantly related to waking symptom reports. Small subject numbers confounded this analysis and further research in this area with larger subject numbers is required. Conclusions: The findings of this study support the need for health professionals to consider individuals’ sleep position and waking symptom history when developing a management plan for troublesome waking symptoms.

Effects of Participation in an Aging Game Simulation Activity on the Attitudes of Allied Health Students Toward Older Adults

Abstract: The Aging Game simulation activity was designed to improve medical students’ attitudes toward older adults. This study was conducted to determine if the Aging Game, adapted for use with allied health students, could yield positive results in the students’ levels of anxiety about aging and attitudes toward aging. The modified Aging Game was implemented at a large Midwestern university with 156 students from three allied health areas – nutrition and dietetics, physical therapy, and long-term care administration. All students actively engaged in the simulation activity and completed pre- and posttest questionnaires containing the Anxiety about Aging Scale (AAS) and the Aging Semantic Differential (ASD) measures. Results indicated most students had low anxiety about aging and positive attitudes toward older adults both before and after the Aging Game activity. Changes in the students’ pre- and posttest scores on AAS and/or ASD measures were mixed, with small differences in average scores. The demographics of the sample group for this study may partially explain the effects the simulation experience had on these allied health students. That some students took on a more negative attitude toward older adults after the simulation could be attributed to a more realistic view of the difficulties and challenges of aging. Also, the shortened timeframe of the Aging Game simulation may have affected the students’ reactions to the activity. Future activities to complement the simulation, such as reflective writing and interaction with older adults, may improve the impact of the Aging Game on the attitudes of allied health students.

Using the Power of Student Reflection to Enhance Professional Development

Abstract: Student personal and professional development is an area of increasing importance in professional education programs. The practitioner of the future needs to be able to reflect and self-assess his/her learning in order to take intentional steps toward developing or continuing competency. The purpose of this article is to describe the evolution of one program’s process of incorporating self-reflection and feedback as an integral part of the curriculum. Examples of the guiding questions are included. The value of a self-reflective student evaluation process in the development of reflective practice and its implementation within a professional healthcare curriculum and future practice environments are discussed. The assessment of personal and professional student development requires careful study of behavior, attitudes, and performance. Yet, it is admittedly often a subjective task. As discussed by Kasar, many faculty in professional programs of study realize the challenges to accurately evaluating skill development, especially when the skills include the ability to communicate effectively with diverse populations, or to self-monitor one’s behavior in practice settings. 1 Skills such as these cannot be taught in lecture nor assessed in written examinations. Instead, the student needs to learn selfreflective assessment skills and engage in dialogue with faculty regarding possible ways to improve the learning process.

Challenges facing physiotherapy education in Africa

Abstract: Health care is changing and the demands put on health professionals are increasing. Physiotherapy education should reflect the health and social priorities of the nation. The World Confederation of Physical Therapy (WCPT) is committed to assisting physiotherapy associations in developing educational standards. Physiotherapy education in Africa however, seems to have a real need for assistance from the WCPT. The aim of this paper is to highlight the challenges facing physiotherapy education in Africa. The Delphi methodology was used to obtain information from key informants involved in the area of physiotherapy education from a variety of African countries. The majority of the participants were people who have experienced physiotherapy education in Africa either as graduates or current teachers. Data were analyzed into themes and sent back to respondents for confirmation. The most important challenges highlighted were: lack of undergraduate training opportunities, limited number of therapists, upgrading of physiotherapy educators, research as a major component of physiotherapy education, and recognition of physiotherapy as an essential service. It is concluded that assistance is needed for physiotherapists from Africa to take their rightful place in the health team and higher education institutions should look at improving diploma qualifications of physiotherapists in African countries.

Compassion and Integrity in Health Professions Education

Abstract: Issues related to professionali sm have come to the fore in health professions education. Strategies designed to evaluate and increase components of professionalism are now of interest to educators. Skills in improving levels of professionalism can be accurately assessed and taught. Professionalism encompasses attributes of compassion and integrity. Tools to measure indices of compassion have been developed. There are three critical stages in which attributes of compassion and integrity can be assessed: prior to admission, during education, and graduation standards. One effective means of transferring skills related to professionalism is modeling. Health professions educators need to be more aware of the issues related to the assessment of elements of professionalism

Can human patient simulators be used in physiotherapy education

Abstract: Purpose: The purpose of this study was to review the evidence for the use of human patient simulators in physiotherapy education. Method: A review of the physiotherapy literature was undertaken. Due to the lack of studies found the search was expanded to include health professional education. Exclusion criteria were then applied to the identified literature and critical appraisal undertaken. Results: Due to the differences in methodology employed in the studies identified a meta-analysis could not be performed. The studies identified repeat practice and the ability to control the learning environment as positive aspects for learning using human patient simulators. In medical education psychomotor skills improved when simulators where used. Conclusions: Conclusions were not able to be drawn regarding whether the use of human patient simulators leads to improved patient management in a clinical environment especially in the field of physiotherapy. A controlled study investigating cardiorespiratory physiotherapy clinical performance is recommended to determine whether human patient simulators should be used in physiotherapy education.

Obesity and Its Role in Oral Health

Abstract: Obesity is a serious public health concern that has reached epidemic proportions. This paper addresses the role obesity plays in several health conditions, in addition to how it negatively affects a person’s oral health. Oral health care providers can have a positive impact on treatment outcomes by recognizing patients at risk for obesity and addressing these issues.

Quantifying Instructional Interventions in Pediatric Physical therapy with the Motor Teaching Strategies Coding Instrument (MTSCI-1): A Pilot Study

Abstract: Purpose: This paper presents the development and preliminary psychomotor testing of a new instrument, the Motor Teaching Strategies Coding Instrument (MTSCI-1), designed to quantitatively assess motor-teaching strategies used by physical therapists during therapeutic interventions with children. Method: The MTSCI-1 was developed to evaluate the use of strategies grounded in motor learning theories and concepts. The items were generated from a review of the literature. To evaluate reliability, two physical therapists used the MTSCI-1 to code videotaped treatment sessions of pediatric physical therapists. Kappa was calculated. Validation was examined by comparing scores of physical therapists with different years of experience. Results: The resulting instrument had two main sections: (a) task/movement characteristics, and (b) before-, during- and after-task strategies. Each activity trial was analyzed and frequency of strategies used was determined. Percentage of agreement and preliminary inter- and intra-rater reliability ( κ=.66-.94) as well as content and construct validation were established. The instrument differentiated the use of some strategies among groups of physical therapists with varied years of experience. Conclusions: The MTSCI-1 may be considered in research studies to document the motor-teaching strategies of physical therapists. The MTSCI-1 may also facilitate the learning and training of therapists from various fields in the application of motor learning to maximize clients’ outcomes from their motor-teaching activities.

Understanding Sleep Quality and Waking Cervico-Thoracic Symptoms

Abstract: Purpose: Using data from an epidemiological study described elsewhere (Gordon et al 2002 & 2007), multivariate logistic regression models were constructed to explore the association between sleep position, factors related to sleep quality, and the prevalence of waking symptoms (cervical spine pain and stiffness, headache, and aching in scapulae or arm regions). Method: A causal model was developed in which putative exposures were tested for their association with sleep quality, which was considered as an antecedent cause of waking cervico-thoracic symptoms. Results: Factors which significantly constrained sleep quality were identified as the presence of a medical condition, past history of injury or accident to the cervical spine, sleep position, and nocturnal bruxism. Poor sleep quality was significantly related to waking cervico-thoracic symptoms. Conclusions: The significant relationships between these factors highlight the need for assessment of all possible causes of waking cervico-thoracic symptoms in the clinical setting.

Descriptive and Process Evaluation of a Shared Primary Care Program

Abstract: Purpose: This study involved the conduct of a descriptive and process evaluation to examine the implementation and maintenance of an existing local shared care program: The Hamilton Health Service Organization Mental Health and Nutrition Program located in the Hamilton, Ontario, Canada. The program was organized to strengthen links between mental health, nutrition, and primary care services, to improve access to mental health and nutrition care, and to realize the benefits of improved communication, collaboration and mutual support among multiple practitioners, increased continuity of care, and increased family physicians’ comfort and skill in handling more complex problems. Method: A mixed-method, multi-measures evaluation design was used. Data were gathered from the program’s central patient database and by conducting focus groups. Results: Teams of practitioners provide comprehensive primary mental health and nutrition care. Collaboration and education opportunities are extensive although time constraints are an issue. Patients with a range of problems were assessed, treated, and referred among team members. There appears to be a decreased burden on external services. Conclusions & Discussion: This evaluation suggests that implementation and maintenance of shared care programs are possible within community practices.

Knowledge, Attitudes, and Confidence Levels of Dental Hygiene Students Regarding Teledentistry: A Pilot Study

Abstract: Teledentistry provides a viable option for dental professionals to increase care in underserved areas. Dental hygiene students at a state university completed a course in teledentistry that includes performing oral health screenings on children using intraoral cameras and electronic submission of dental images to an off-site dentist for diagnosis. Purpose: The objectives of this study were to examine student knowledge, attitudes, and confidence levels before and after completion of a course on teledentistry. Method: A 5-point Likert scale survey consisting of 10 items was administered to students ages twenty-two to twenty-five (N=24) in a teledentistry course the first and last day of class. The survey included current knowledge of teledentistry, attitudes regarding effectiveness of teledentistry, and confidence in acquiring the necessary technical skills. Results: Survey results were analyzed using a matched-pairs t-test and Wilcoxon signed-rank test. There were significant increase in student knowledge, attitudes, and confidence in 9 of the 10 questions (p<.01). Conclusion: This study indicates that student attitudes were positively changed in their knowledge of the effectiveness of teledentistry in identifying dental needs in underserved areas, the role dental hygienists play in access to care, and confidence in acquiring and submitting dental images. These findings, in conjunction with research by other investigators, support continued implementation of teledentistry in dental hygiene education.

For Falls Sake: Older Carers' Perceptions of Falls and Falls Risk Factors

Abstract: Purpose: Older carers play an important role in falls prevention through their influence over their dependent’s actions and by their own behaviour. This study aimed to determine the perceptions of falls and fall-related risk factors by older carers in an Australian metropolitan community to inform the development of effective falls prevention strategies in this population. Method: A questionnaire was mailed to all members of a carers group in January 2003 and responses from carers aged 60 years or above were included in the study (n=121). Results: The majority of older carers (85%) understood that falls are a problem for their age group and that falls can be prevented (74%). Poor pavement maintenance and balance problems were rated as the most important risk factors for falls. The importance of unsafe behaviour as a falls risk was undervalued. The majority of respondents (74%) indicated they would talk to their doctor if they were concerned about falling. Conclusions and Recommendations: The results of this study indicate that older carers in a metropolitan community acknowledge falls are both important and preventable. The awareness of unsafe behaviour as a falls risk factor needs to be raised. Health professionals are trusted by older carers and should discuss falls prevention strategies with both the older patient and their carer. The next stage is to explore if older carers understand how they can reduce the risk of falling for themselves and their dependents, and how to effectively engage and enable older carers to do this successfully.

Assessing Clinical Placements in a B.Sc. Physiotherapy Program

Abstract: Background: The clinical setting is one of the most valuable educational resources available to institutions training physiotherapy students. The experiences gained at the clinical settings assist graduates to grasp what the discipline of physiotherapy is all about. Objective: To evaluate existing clinical venues providing placement for physiotherapy students at the University of the Western Cape. Methodology: Both quantitative and qualitative methods were employed to gather data. A validated questionnaire was used to gather the quantitative information. The questionnaire consisted of a seventeen-item instrument using a Likert scale which ranged from strongly agree to strongly disagree. Five open ended questions were added to gather qualitative data which would enrich the quantitative responses. The quantitative data was analysed using SPSS and reported using descriptive statistics. The qualitative data were transcribed verbatim by an independent person and emerging themes were identified. Results: The study yielded a response rate of 61%. The majority of the respondents agreed or strongly agreed with the statements relating to satisfaction with clinical placements. The highest negative responses related to the clinicians attitudes and willingness to assist students. Conclusion: Physiotherapy students were found to be satisfied with their clinical rotations but highlighted areas that could be improved to enhance the learning that takes place at the clinical settings.

Clinical educators' reactions to ageing

Abstract: Ageism and negative attitudes towards ageing have been identified within the literature as a cause for concern. Reactions to ageing are known to be strongly positively correlated with attitudes towards older people in general. Moreover, the link between ageist practice and quality of care is also established, but implications for education and training have not been explored. The aim of this study was to investigate the reactions to ageing of clinical and fieldwork educators of undergraduate students. Clinical and field work educators are largely responsible for all the clinical education received by these students and thus have the potential to be to be highly influential in the development of their attitudes towards the elderly. Reactions to ageing were measured among clinical educators registered with a University in South East England using The Reaction to Ageing Scale, and scores were classified into typologies. Results were obtained from 62% (n=87) physiotherapy and 87% (n=81) podiatry clinical educators and 71% (n=53) of occupational therapy fieldwork educators, attending training sessions. There was a significantly greater proportion of gerophiles among the physiotherapists than among the other groups. Podiatry gerophiles were significantly older than gerophiles in the other professional groups. The results

Interdisciplinary Management of Diabetic Eye Disease: A Global Approach to Care

Abstract: Diabetic eye disease is a leading cause of acquired blindness in the United States. Most cases of blindness secondary to diabetes mellitus are preventable. In addition to exercise, proper diet, and aggressive glycemic control, patients with diabetes mellitus should be educated to adhere to established guidelines for an annual dilated retinal evaluation. The ideal model of care for patients with diabetic eye disease is an interdisciplinary, team-oriented approach with the patient as the central member of the healthcare team. The primary purpose of this paper is to present an interdisciplinary approach to management of the ocular complications of diabetes mellitus and to educate clinicians about diabetic eye disease.

Framing a Vision for Physiotherapy Research: Synthesizing Educators' Viewpoints in Cape Town

Abstract: Purpose: The Cape Town region is the largest training locality for physiotherapy training in South Africa. The socio-political changes since the first democratic election in South Africa have impacted on physiotherapy training and clinical practice, although there currently is no evidence-based vision statement for physiotherapy practice in South Africa. This paper reports key findings from interviews held with three prominent physiotherapy educators / administrators in the three Cape Town universities' physiotherapy schools regarding their perspectives on research, clinical teaching and evidence-based practice in physiotherapy. The purpose of this research was to frame a vision for South African physiotherapy, which could underpin profession-wide discussions on equity, accessibility, safety, evidence-base and appropriate-resourced physiotherapy care for all South Africans. Method: A qualitative research design was employed and semi-structured interviews were conducted individually with 3 key participants who each have more than 10 years experience in education at the three physiotherapy tertiary training institutions in Cape Town. The questions sought perspectives on where physiotherapy research education had come from over recent times in South Africa, what contributed to its successes and failures, and what future there was for research and clinical practice in South Africa into the future. Results: The positive points about South African research were that research interest is perceived to be growing for academics and clinicians, postgraduate degrees have been introduced in all Cape Town universities. Negative points were reported included a lack of focus and direction for research and the overwhelming volume of research to be undertaken relative to the changing South African health care scene. Conclusion: The research findings highlight the need for the development of a vision that rises above individual organizations and institutions, and which takes a nation-wide view of future research and its relationship with clinical practice and community need. Background

Effectiveness of Eccentric Exercises in the Management of Chronic Achilles Tendinosis

Abstract: Background: Chronic Achilles tendinosis is commonly seen in clinical practice however the causes are largely unknown. In the last ten years good results have been reported with a range of approaches, one of which is eccentric training. Objective: This study reports on a systematic review of the literature to determine the effectiveness of eccentric training compared with other types of interventions for chronic Achilles tendinosis. Method: A systematic review of the published research literature was conducted to examine the quantity, nature, quality and significance of literature relevant to the effectiveness of eccentric training for chronic Achilles tendinosis. Subject inclusion criteria were being at least 16 years of age, having a minimum of three months of complaints and no other underlying pathologies. Results: Seven databases were searched, and 25 studies were included. They reflected a variety of research designs and study quality. Comparison interventions included surgery, medications and passive treatment. An index combining results and quality showed that the best options for managing Achilles tendinosis were medication and eccentric exercises. Taking account of factors such as cost, safety and inconvenience, eccentric exercises are favoured over drug intervention. Conclusion: Eccentric exercises are simple to perform and provide a cost effective, safe and efficient way to treat Achilles tendinosis. They should be considered first for all patients, before invasive interventions such as surgery and drug therapy. Background

Recognizing Anterior Cruciate Ligament Tears in Female Athletes: What Every Primary Care Practitioner Should Know

Abstract: Purpose: Women have a much higher rate of anterior cruciate ligament injury than men. Anterior cruciate ligament injuries are very expensive as well as physically and emotionally debilitating. Understanding why anterior cruciate ligament injuries are more prevalent in women as compared to men is crucial and addressing these issues to possibly prevent their high occurrence is important. Review of Literature : Hormonal differences, structural differences, musculature differences, and mechanical differences between men and women leave women more susceptible to anterior cruciate ligament injury. While there are many factors contributing to the higher rate of anterior cruciate ligament injury in women versus men, newer research has been devoted to addressing the issues that can be corrected and the discrepancies that can be decreased. Investigators are now taking the results from such research and applying them to women to decrease the occurrence of anterior cruciate ligament injury among this group. Results: Promising outcomes have occurred in neuromuscular and proprioceptive training programs designed to help women strengthen and train the muscles around their knee thus leading to better stabilization and therefore decreasing the incidence of anterior cruciate ligament injury. Conclusion: Future research should be devoted to finding all of the possible factors of the increased incidence of anterior cruciate ligament injury in women and all potential avenues for preventing these injuries should be studied. Background

Recognizing Guillain-Barré Syndrome in the Primary Care Setting

Abstract: Purpose: Guillain-Barre’ Syndrome (GBS) is the most common cause of acute flaccid paralysis in adults and children in the United States. The purpose of this article is to educate Primary Care Practitioners (PCP) about GBS and the importance of its recognition in the acute care setting. Method: A review of literature examined epidemiology, pathophysiology, clinical features, and antecedent events related to primary care. Results: Studies show correlations between GBS and preceding viral-bacterial infections, and certain vaccines. However, a direct causation has not been proven. Antecedent events encountered in primary care include, but are not limited to, gastroenteritis, upper respiratory infection, cytomegalovirus, Epstein-Barr virus, and vaccinations against influenza, meningitis, and tetanus toxoid. Conclusion: PCPs should be able to recognize GBS and its triggers should a case present to their clinics. It is hoped that GBS mortality and sequela would be decreased if PCPs are more knowledgeable about this condition.

Physical Therapy Students' Perspectives on Disability

Abstract: Purpose: The purpose of this qualitative study was to examine physical therapy students’ learning about disability through an Exploring Perspectives on Disability (EPOD) learning event that was developed by the School of Rehabilitation Science, McMaster University. EPOD consists of two scheduled classes discussing disability, a shadowing experience with an individual with a disability living in the community, and writing a reflective summary assignment about their learning. The EPOD was developed to broaden students’ perspectives regarding disability, promote a positive attitude about disability, and facilitate best practice approaches in community-bas ed care. Method: Fifty-seven students in the first semester of a Master’s entry level physical therapy program completed the EPOD event. In the reflective summary, they were asked to describe and reflect on their experiences and observations about the individual they shadowed. The summaries were transcribed into NUD*IST, a computerized software program for qualitative data management. Each summary was read by two of four investigators who independently read, coded, and categorized the entries, and then worked together to identify themes. Results: Three major themes were identified: (1) students’ assumptions about disability were challenged; (2) their understanding about supports and barriers for people with disability was enhanced; and (3) they acknowledged the professional growth and learning that occurred. Conclusions: Through the EPOD learning event, students gained new knowledge about disability and their attitudes about people with disability were influenced. The EPOD was important in broadening their perspectives concerning disability and promoting a positive attitude about disability.

Relation Between Payer Source and Functional Outcomes, Visits and Treatment Duration in Patients with Lumbar Dysfunction

Abstract: Background: The differences in the utilization of healthcare services and resultant charges for symptoms like back pain has necessitated payers of healthcare services in the United States (US) to make efficient decisions relative to resource utilization. Studies involving both public and private payers of healthcare services in the United States have shown that payer source makes a difference in utilization of resources and patient outcomes. With the current focus on efficient and effective treatment, further research is needed on the relationship between payer source and patient outcomes. Purpose: To examine the association between payer source and number of visits, duration of treatment, and discharge functional status (FS) for patients with lumbar dysfunction who received physical therapy (PT) services. Methods: This retrospective study used secondary analyses of the Focus On Therapeutic Outcomes, Inc. (Knoxville, TN, USA) database that contained FS measures, number of visits, and treatment duration. Data were analyzed from 16,977 patients who received PT for lumbar dysfunction. Patient self-report surveys were used to estimate risk-adjusted FS at discharge. Therapists reported number of treatment visits and calendar days of treatment duration. Results: Patients receiving benefits from indemnity insurance and managed care plans (private funding) reported the highest risk-adjusted discharge FS measures. Patients receiving benefits from Medicaid (public funding) reported the lowest discharge FS measures and least number of visits. Patients receiving benefits from Workers’ Compensation and patients involved in litigation had the longest treatment duration and highest number of visits. Conclusion: Results suggest that patients receiving benefits from different payers of healthcare services may differ in utilization of resources and outcomes. Further study is needed across a variety of diagnoses and payer sources to investigate the effect of payer source on utilization of physical therapy services and patient outcomes.

A Study of the Self-Regulated Learning Inventory on a HBCU Student Population in Allied Health

Abstract: Increased numbers of minorities in the allied health disciplines are sought for a number of reasons. One approach to increasing minority graduates in allied health sciences is to ensure that minority applicants have the learning behaviors necessary to succeed in the academic setting. In this study, we sought to determine if self-regulate d learning, assessed via a self-report inventory, was significantly related to Grade Point Average (GPA) in undergraduate students enrolled in a historically black college or university (HBCU). The Self Regulated Learning Inventory V. 5 (SRLI V.5) was distributed to undergraduate HBCU students enrolled in allied health majors. The inventory was completed by 134 undergraduate students who provided the data for the study. Results indicated that the SRLI was not significantly correlated with academic success (based on student GPA). Further investigation revealed that different methods used in calculating GPA and the inclusion of transfer students likely decreased the statistical power of the association between academic performance and self-regulation.

The Prevalence of Incontinence Pre- and Post-Lung Transplantation

Abstract: An increased prevalence of urinary incontinence (UI) is reported in patients with chronic lung disease because of the stress that repeated coughing places on the pelvic floor. To date, it is not known if lung transplantation (LTx) affects the prevalence of UI. Purpose: to compare the prevalence, severity and impact of urinary / faecal incontinence in adult patients pre- and post-LTx. Method: patients registered with the Royal Adelaide Hospital Lung Transplant Unit were eligible for participation. The prevalence, severity, and impact of incontinence was measured using a questionnaire administered in a private interview. Results: Ninety-four patients (44 males, 50 females; 42 pre-LTx, 52 post-LTx; mean age 46.3 years [SD 13.0]) completed the questionnaire. The prevalence of UI was significantly higher in patients pre-LTx (69.0%) than patients post-LTx (30.8%), whereas the prevalence of faecal incontinence was similar in the two groups (16.7% pre-LTx, 13.5% post-LTx). In most patients with UI, it was episodic, the amount leaked was small, it was most often associated with coughing and sneezing, and it was perceived as causing few problems. Conclusion: LTx appears to be associated with a significant decrease in the prevalence of UI.

Migraine and Risk of Stroke in Young Women

Abstract: Purpose: To explore the relationship between migraine and incidence of stroke in young women by analyzing variables of oral contraceptive use, hypercoagulability, cardiac abnormalities, and silent brain infarcts. Method: Variables were reviewed through computerized databases and current literature examining evidence-based medicine studies specific to analyzing the incidence of strokes in women with migraines. Results: Six recent studies, four case control and two cohort studies, were identified. Research outcomes indicate that the risk of stroke is greater in women less than 35 years of age who had migraine with aura and who used oral contraceptives. Other pathophysiologic variables, which may link migraine to stroke, include hypercoagulability, cardiac abnormalities, and silent brain infarcts. Conclusion: Young women with migraine appear to be at higher risk of ischemic stroke than women without migraine. This risk is further increased by the co-existence of other established risks including hypertension, smoking, and oral contraceptives. Patent foramen ovale, silent brain infarcts, and hypercoagulability are underlying mechanisms that appear to link migraine to stroke. Clinical studies and research into the pathophysiology of migraine is essential to explain why migraine patients are at higher risk of ischemic stroke.