february 2019 vol. 19 // no. 1€¦ · abstracts from the award-winning platform and poster...

Official Publication of the Section on Health Policy & Administration of the American Physical Therapy Association

Physical Therapy Journal of Policy, Administration and Leadership

February 2019Vol. 19 // No. 1

Vol 19 Issue 1 Physical Therapy Journal of Policy, Administration and Leadership

The Catalyst

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3

TABLE OF CONTENTS HPA the Catalyst

Physical Therapy Journal of Policy, Administration and Leadership

PresidentMatthew Mesibov, PT, GCS

[email protected]

Vice PresidentKaren Hughes, PT

[email protected]

SecretaryJames Eng, PT, DPT, MS, GCS

[email protected]

TreasurerLori Pearlmutter, PT, MPH

[email protected]

Director of ScholarshipDawn Magnusson, PT, PhD

[email protected]

Director of OperationsAmit Mehta, PT, DPT, MBA

[email protected]

Director of Social Responsibility & Global Health

Jennifer Audette, PT, [email protected]

Director of Technology & InnovationRobert Latz, PT, DPT, CHCIO, [email protected]

Director of LAMPEmily Becker, PT

[email protected]

Publications ChairEd Dobrzykowski, PT, DPT, ATC, MHS

[email protected]

Managing Editor • PTJ-PALDianne V. Jewell, PT, DPT, PhD,

[email protected]

Section Office • Editorial Coordinator Caitlin Price

2400 Ardmore Blvd Ste 302

Pittsburgh, PA 15221877-636-4408

[email protected]

Vol 19 Issue 1 Physical Therapy Journal of Policy, Administration and Leadership

Articles accepted via our online submission system. Visit www.aptahpa.org/PTJPAL for more information and to submit your manuscript.

The Physical Therapy Journal of Policy, Administration and Leadership (PTJ-PAL) is a publication of the Section on Health Policy & Administration. The Section reserves all rights through the Editors, Officers, and Executive Director to refuse publication of any advertisement or sale of member list.

All advertisements or orders are accepted on the basis of conformance with the APTA Code of Ethics, Standards of Practice, and the policies and positions of the above sections. Acceptance of advertisement or use of lists by another party does not imply endorsement by HPA The Catalyst: Section on Health Policy and Administration of APTA.

Articles published in HPA PTJ-PAL are the work of the authors and do not necessarily represent the opinions, research, or beliefs of HPA The Catalyst: Section on Health Policy and Administration of the APTA.

2019 Submission Deadlines:Jan. 9, 2019 (digital release date – Feb. 4, 2019)April 5, 2019 (digital release date – May 6, 2019)July 12, 2019 (digital release date – Aug. 5, 2019)Oct. 4, 2019 (digital release date – Nov. 4, 2019)

ISSN: 1931-6313HPA Resource/PTJ-PAL is indexed by EBSCO. www.ebsco.com.

HPA The Catalyst is the Section on Health Policy and Administration, a specialty section of the American Physical Therapy Association.

Letter from the Managing Editor D. Jewell, PT, DPT, PhD, FAPTA

GLOBAL HEALTH Impact of Physical Therapist Training, Experience, and Role Certainty on Confidence when Responding to a Public Health Event Crisis P. Berg-Poppe, PT, PhD // C. Hilfman, DPT // M.D. Diaz Talja-Binoya, DPT // H. Vyas, DPT

HEALTH POLICY Effects of “On the Move” Exercise Program on Falls and Healthcare Utilization in Older Adults P. Coyle, PT, DPT, PhD // S. Perera, PhD // S. Albert // J. Freburger, PT, PhD // J. VanSwearingen, PhD, PT // J. Brach, PT, PhD

PRACTICE ADMINISTRATION Using Clinical Data to Drive Clinical Practice: Bringing Practice Change to Scale P. Scheets, PT, DPT, MHS // M. Billings, PT, DHSc, MS // P. Hennessy, PT, MPT

4

5

22

23

Vol 19 Issue 1 Physical Therapy Journal of Policy, Administration and Leadership4 Physical Therapy Journal of Policy, Administration and Leadership Vol 19 Issue 1

The 2019 New Year’s celebration has passed, and with it, the one-year anniversary of my editorship! As the song goes, we shouldn’t forget those “days gone by” – but we shouldn’t linger in the sweetness of their nostalgia either. Instead, now is a good time to evaluate our

progress, and refine our aim toward our vision for the journal. This commitment to performance improvement is apropos of HPA The Catalyst and its mission to transform our professional culture. Our look back provides reasons to be proud, yet also points the way to next steps on our path.

Here is a snapshot of our 2018 accomplishments. Together, the PTJ-PAL editorial team delivered:

• an increase to a quarterly publication schedule;

• a re-organization of the table of contents for ease of navigation to topics of interest;

• a re-design of the journal landing page for easier access to current and archived issues;

• the addition of seven new reviewers to our editorial team; and

• the launch of an electronic manuscript management platform to facilitate submission and review activities.

These efforts are small but important building blocks for our next round of initiatives. In 2019, those include additional delineation of roles and responsibilities for our editorial work, further refinement of the submission platform functionality, and increased efforts to expand our manuscript submission pipeline. We’re marching forward with the simultaneous mission of sustainability and growth, and we invite you to come along for the journey.

This issue provides yet another reason why I think you’ll find your time is well spent among our pages. Berg-Poppe and colleagues identify opportunities for practice growth through their exploration of physical therapists’ experiences with, and perceived readiness to respond to, public health event crises. Their timely description coincides with a 2018 APTA House of Delegates charge to support our engagement in these catastrophes. That some of our members were directly impacted by natural and man-made disasters in recent years reinforces the urgent need to clarify our roles and provide related education and training in public health events.

Abstracts from the award-winning platform and poster presentations delivered at the 2019 Combined Sections Meeting in Washington, D.C., also challenge us to use information from “days gone by” to inform our future contributions to the health of society. Coyle and colleagues investigate whether an exercise program designed to improve walking ability in community-dwelling older adults might also reduce their need for emergency department visits and subsequent hospitalization. Scheets and colleagues, on the other hand, use their own practice data to identify clusters of patients that differed in their outcomes in order to focus performance improvement initiatives on the low value experiences.

All three of these contributions lay groundwork that can serve as springboards for our professional evolution. Looking back to “auld lang syne” so that we can move forward in our knowledge and abilities to improve the health of society…I can’t think of a better cause to serve through this journal!

Dianne V. Jewell, PT, DPT, PhD, FAPTA

PTJ-PAL Managing Editor

Dianne V. Jewell, PT, DPT, PhD, FAPTALETTER FROM THE

MANAGING EDITOR

"Auld Lang Syne"...but Only for a Moment

5

ABSTRACT

Vol 19 Issue 1 Physical Therapy Journal of Policy, Administration and LeadershipPhysical Therapy Journal of Policy, Administration and Leadership Vol 19 Issue 1

The 2019 New Year’s celebration has passed, and with it, the one-year anniversary of my editorship! As the song goes, we shouldn’t forget those “days gone by” – but we shouldn’t linger in the sweetness of their nostalgia either. Instead, now is a good time to evaluate our

progress, and refine our aim toward our vision for the journal. This commitment to performance improvement is apropos of HPA The Catalyst and its mission to transform our professional culture. Our look back provides reasons to be proud, yet also points the way to next steps on our path.

Here is a snapshot of our 2018 accomplishments. Together, the PTJ-PAL editorial team delivered:

• an increase to a quarterly publication schedule;

• a re-organization of the table of contents for ease of navigation to topics of interest;

• a re-design of the journal landing page for easier access to current and archived issues;

• the addition of seven new reviewers to our editorial team; and

• the launch of an electronic manuscript management platform to facilitate submission and review activities.

These efforts are small but important building blocks for our next round of initiatives. In 2019, those include additional delineation of roles and responsibilities for our editorial work, further refinement of the submission platform functionality, and increased efforts to expand our manuscript submission pipeline. We’re marching forward with the simultaneous mission of sustainability and growth, and we invite you to come along for the journey.

This issue provides yet another reason why I think you’ll find your time is well spent among our pages. Berg-Poppe and colleagues identify opportunities for practice growth through their exploration of physical therapists’ experiences with, and perceived readiness to respond to, public health event crises. Their timely description coincides with a 2018 APTA House of Delegates charge to support our engagement in these catastrophes. That some of our members were directly impacted by natural and man-made disasters in recent years reinforces the urgent need to clarify our roles and provide related education and training in public health events.

Abstracts from the award-winning platform and poster presentations delivered at the 2019 Combined Sections Meeting in Washington, D.C., also challenge us to use information from “days gone by” to inform our future contributions to the health of society. Coyle and colleagues investigate whether an exercise program designed to improve walking ability in community-dwelling older adults might also reduce their need for emergency department visits and subsequent hospitalization. Scheets and colleagues, on the other hand, use their own practice data to identify clusters of patients that differed in their outcomes in order to focus performance improvement initiatives on the low value experiences.

All three of these contributions lay groundwork that can serve as springboards for our professional evolution. Looking back to “auld lang syne” so that we can move forward in our knowledge and abilities to improve the health of society…I can’t think of a better cause to serve through this journal!

Dianne V. Jewell, PT, DPT, PhD, FAPTA

PTJ-PAL Managing Editor

Impact of Physical Therapist Training, Experience, and Role Certainty on Confidence when Responding to a

Public Health Event Crisis

Patti Berg-Poppe, PT, PhDProfessor and Interim ChairUniversity of South DakotaVermillion, SD

Cynthia Hilfman, PT, DPTPhysical TherapistVeteran’s Heath Administrationof the Greater Los Angeles Areaand The Los Angeles Country ClubLos Angeles, CA

Maria Daphne Diaz Talja-Binoya, PT, DPTPhysical TherapistSelf Regional HealthcareGreenwood, SC

Hemang Vyas, PT, DPTPhysical TherapistMemorial Herman Health SystemsHouston, TX

Patti Berg-Poppe, PT, PhD // Cynthia R. Hilfman, DPT //Maria Daphne Diaz Talja-Binoya, DPT // Hemang Vyas, DPT

Corresponding Author:Patti Berg-Poppe, PT, PhDUniversity of South DakotaDepartment of Physical Therapy414 East ClarkVermillion, SD [email protected]

"Auld Lang Syne"...but Only for a Moment

Objectives. A lack of clearly defined professional roles has left physical therapists feeling underutilized as Public Health Event (PHE) personnel. The study’s purpose was to understand the value of training and experience on physical therapists’ and physical therapist assistants’ confidence to respond to PHEs.

Background. PHEs include incidences capable of causing widespread human, material, economic, and environmental loss and having the potential to overwhelm community health infrastructure.

Study Design. The study design was cross-sectional.

Methods and Measures. A web-based, literature informed survey was developed and validated by content experts. The survey link was disseminated through email and newsletter, and recipients were encouraged to share the link with licensed physical therapists and physical therapist assistants.

Results. Participants were 395 licensed physical therapists and 12 physical therapist assistants from 35 states in the U.S. Analyses were limited to physical therapists only due to the low assistant response rate. Various types of disaster response training as well as practice experience with acute and subacute conditions had a positive effect on confidence in working with victims of PHE compared to physical therapists without this background. Those who believed physical therapists have experience that can be utilized in PHE relief also believed physical therapists should be involved in disaster policy planning (p < .001).

Conclusion. PHE curriculum and minimum competencies specific to the physical therapist’s unique contribution to the interprofessional response team should be articulated to clarify role ambiguity and bolster the knowledge and confidence of physical therapists interested in response involvement before, during, and/or after a PHE.

Institutional Affiliation. University of South Dakota.

GLOBAL HEALTH

6 Physical Therapy Journal of Policy, Administration and Leadership Vol 19 Issue 1

Impact of Physical Therapist Training, Experience, and Role Certainty on Confidence when Responding to a Public Health Event Crisis

IntroductionPublic health events (PHEs) – such as hurricanes, earthquakes, fires, tornados, mass shootings, terror attacks, epidemics and pandemics – cause widespread human, material, economic, and environmental losses. A PHE is defined as an ‘uncommon event’ having the potential to overwhelm community health infrastructure.1 The Centre for Research on the Epidemiology of Disasters defines disasters as events or situations that overwhelm local capacity, and, thus, require external assistance from national or international bodies.2 Medical attention is provided in response to PHE-related acute illness and routine follow-up care, exacerbation of chronic illness and mental health, physical injury, and medical disposition (decisions to treat or refer -- including field care triage and referrals to higher level of care, emergency department (ED), pharmacy, or physician).3 Physical therapists who have provided care as front line healthcare personnel in disaster situations report feeling underutilized due to poorly defined roles.4 Possible roles identified include assessment of rehabilitation potential during field (on site) or facility triage phases, facilitation of discharge by assisting patients to functionally recover5, and implementation of rehabilitation plans for care and training.5 In fact, physical therapists possess a skill set of great value to the aims of the National Preparedness Goal,6 which supports efforts toward “a secure and resilient nation with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from, the threats and hazards that pose great risk.”6(p1) A sample of the many pre- and post-PHE needs and actions within the scope of physical therapist practice is depicted in Figure 1.

Since Aug. 1, 2017, several types of PHEs, including geophysical (e.g., earthquakes in Mexico City and Anchorage, Alaska), meteorological (e.g., hurricanes Harvey, Irma, Jose, Maria, Florence and Michael), human-action incidences (e.g., bombing

of a London subway; mass shootings in Las Vegas, Nevada, Parkland, Florida, and Pittsburgh, Pennsylvania), climatological (e.g., fires in northern and southern California), and hydrologic (e.g., flooding and mudslides in Montecito, California) have taxed local infrastructures and national aid agencies. Natural disaster statistics report the occurrence of an average of 500 events annually, compared to 120 per year in the 1980s.1 More than an estimated 100,000 lives are lost annually as a result of natural disasters.7 Global climate change brings the potential for an increasing number of severe climatological events.8 Disasters affect communities by destruction of infrastructure, loss of communication, and disruption of public utilities, and, depending on the severity, leave victims injured and homeless.8 Natural and human-action disasters occur without regard to an area’s level of preparedness, and most result in casualties that require rehabilitation.9

The World Health Organization (WHO)10

has identified medical rehabilitation experts such as physical therapists as part of a team that has a critical role in the conservation of body function, activity, and participation following a disaster.11 Minimum technical standards for emergency medical teams in the likelihood of sudden onset disaster have been established with rehabilitation professionals, including physical therapists, as central to the response team efforts. The workgroup establishing these standards concluded there was a need for “at least one rehabilitation professional per 20 beds at the time of initial deployment, with further recruitment depending on case-load and local rehabilitation capacity” and that a specialized team must “include at least three rehabilitation professionals of at least two disciplines, one of whom must be a physiotherapist.”10

Several articles document the personal experiences of physical therapists following earthquakes in places like Nepal,12

Haiti,13 and New Zealand,14 as well as following terror attacks in Bali,4 Oklahoma

City,15 and the World Trade Centers in Manhattan.15 The lessons learned following the 2010 earthquake in Haiti included the importance of rehabilitation services and, specifically, the necessity of incorporating physical therapists into disaster planning.5 The literature recognizes the importance and necessity of physical therapists in PHEs, but there are remarkably few studies examining the roles and readiness of physical therapists in emergency disaster response.16 In fact, the role of physical therapists in responding to disasters is generally poorly defined.11

Healthcare personnel facilitate community resiliency in the face of a disaster through the provision of medical support.13 This aim aligns well with the core value of social responsibility and Principle #8 of the American Physical Therapy Association’s (APTA) Code of Ethics, which states that physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally.17 The complex management of PHEs requires involvement from multiple disciplines; the responsibility is not asserted by a single entity, organization, or jurisdiction. During catastrophic events, all healthcare personnel have a role in “nonroutine” practice areas. Each discipline must define and understand its individual role in these situations.18

Noji8 comments that local populations almost always cover immediate lifesaving needs but that medical personnel with skills not available in the affected community are essential toward assessing the needs of the disaster-affected populations and matching resources efficiently to prevent further adverse health events and promote resilience. Many nongovernmental organizations (NGOs) respond following a disaster, but they frequently lack the basic education and knowledge specific to the injuries sustained. Disaster preparedness must not only include first aid and injury prevention; professionals like doctors and nurses must also be knowledgeable about long-term disability management.9

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Reflecting on the Bam, Iran, earthquake of 2003, Raissi and colleagues9 assert that educating both the general population and professionals involved in the care of victims is an essential responsibility for the rehabilitation specialist. Inadequate education on bladder care, lack of attention to pain management, and scarcity of knowledge in the maintenance and repair of high technology wheelchairs, rendering them useless, were among the rehabilitation issues identified by Raissi et al.9 as problematic.

According to the World Confederation for Physical Therapy,19 physical therapists are essential participants capable of providing expertise in the prevention, preparedness, response, and recovery phases of the disaster continuum. Physical therapists are experts at bracing, casting, wheelchair fitting, assistive device fitting/training, mobilizing patients, wound care, burn care, and positioning and exercise to prevent secondary complications.19 However, physical therapists are rarely involved in disaster planning and policy development. In fact, few of the NGOs providing disaster relief include physical therapists as part of their planning teams.16 The underutilization of physical therapists during PHEs is often attributed to a poor understanding of the physical therapists’ skill set and scope of practice by disaster service agency leaders.15 In disaster situations, however, no system exists for the accreditation or evaluation of the skill levels of medical professionals who volunteer during catastrophic events.20 As a result, the literature reports inaccurate assessments leading to misdiagnosis, failure to observe precautions like log rolling and immobilization, insufficient patient education, and poor coordination for transition back to the community.9,20

The United States Military provides an excellent model of organizational preparation and extensive training of physical therapists for emergency situations.15,16 Military physical therapists play a vital role in triage, treating acute orthopedic trauma, wound care, and

respiratory care in critical care settings.15,16

The Veterans Health Administration (VA) supports disaster relief when deployed by the Federal Emergency Management Agency (FEMA) to assist with medical services. This tactic is enacted by calling on a national volunteer resource referred to as Disaster Emergency Medical Personnel System (DEMPS), which deploys clinical personnel to disaster sites for waves of 14-day deployments.

Anecdotally, following Hurricane Maria in September 2017, two physical therapists, one with orthopedic and ED experience and the other with inpatient rehabilitation experience, deployed with the 4th wave of DEMPS.21 Because there were no clearly established care patterns already in place for these physical therapists, their first action required establishing services and communicating with other healthcare personnel the specific skill set that they possessed. Next, the physical therapist responders completed a needs assessment, including gaining an understanding of the services and resources in place, developing an awareness of patient needs, and gathering information to support patients’ current needs. Involvement included medical triage, orthopedic interventions, limb management, wound and debridement care, and supportive care as needed. All patients required evaluations with complete histories and an assessment of current function. Because of the nature of the disaster, many patients presented with mobility problems well addressed by a physical therapist.

Deployment outcomes reported by these physical therapists included a more rapid return of function and community reintegration.21 Yet, in spite of strong organizational support for physical therapy involvement in PHEs, on field, these therapists found it necessary to communicate the asset they presented to a healthcare team, suggesting a role-ambiguity that would benefit from advance clarification. The two reflected that the experience affirmed a belief that the

profession must “further test the full scope of practice”21, p.21 and that it will be necessary to assume leadership positions within response agencies to educate others about the competencies and benefits of physical therapy as a part of the disaster relief team.

One of the main obstacles in civilian emergency response is organizational. The lack of official recognition of what skills physical therapists possess and the value of what physical therapists bring to an emergency situation is a major barrier to participation. It is incumbent on individual physical therapists and the profession as a whole to educate the emergency preparedness community on its unique skills. While there is general agreement among international health organizations that physical therapists play an important role in supporting disaster relief efforts, there are no studies that gauge physical therapists’ beliefs and attitudes about readiness to engage in response during any phase of the disaster continuum. The literature specific to the role that physical therapists play in PHE response is largely anecdotal and describes the many experiences that physical therapists have had from the perspectives of organizational and infrastructural levels.

An exploratory study by Harrison16 queried physical therapists with experience in the emergency phase of disaster response. Emerging themes included role ambiguity among physical therapists and poor organizational utilization of physical therapists' specific knowledge and skill set. Given the agreement that physical therapists serve an important role in all phases of the disaster continuum and because little is reported about their involvement and preparedness for such events in the United States (U.S.), the purpose of this study was to examine beliefs among physical therapists and physical therapist assistants about response readiness and to survey perceived self-efficacy among those tasked with employing specific skills and knowledge during and after a PHE. Furthermore, as factors such as years of clinical experience

Impact of Physical Therapist Training, Experience, and Role Certainty on Confidence when Responding to a Public Health Event Crisis Impact of Physical Therapist Training, Experience, and Role Certainty on Confidence when Responding to a Public Health Event Crisis


profession must “further test the full scope of practice”21, p.21 and that it will be necessary to assume leadership positions within response agencies to educate others about the competencies and benefits of physical therapy as a part of the disaster relief team.

One of the main obstacles in civilian emergency response is organizational. The lack of official recognition of what skills physical therapists possess and the value of what physical therapists bring to an emergency situation is a major barrier to participation. It is incumbent on individual physical therapists and the profession as a whole to educate the emergency preparedness community on its unique skills. While there is general agreement among international health organizations that physical therapists play an important role in supporting disaster relief efforts, there are no studies that gauge physical therapists’ beliefs and attitudes about readiness to engage in response during any phase of the disaster continuum. The literature specific to the role that physical therapists play in PHE response is largely anecdotal and describes the many experiences that physical therapists have had from the perspectives of organizational and infrastructural levels.

An exploratory study by Harrison16 queried physical therapists with experience in the emergency phase of disaster response. Emerging themes included role ambiguity among physical therapists and poor organizational utilization of physical therapists' specific knowledge and skill set. Given the agreement that physical therapists serve an important role in all phases of the disaster continuum and because little is reported about their involvement and preparedness for such events in the United States (U.S.), the purpose of this study was to examine beliefs among physical therapists and physical therapist assistants about response readiness and to survey perceived self-efficacy among those tasked with employing specific skills and knowledge during and after a PHE. Furthermore, as factors such as years of clinical experience

are often positively associated with higher levels of confidence within clinical professions,22 this study also aimed to understand the influence of demographic and professional characteristics on physical therapists’ and physical therapist assistants’ beliefs and confidence.

MethodsSubject Selection

The initial study participants were recruited from a 6-state sample of convenience via email invitation or newsletter to access a published link to the online survey. Contact information was obtained with the cooperation of the states’ licensing agencies. Two of these states, including one from the western region (Pacific division) and one from the southern region (South Atlantic division), had recently experienced meteorological (hurricane) and climatological (wildfire) events. One state in the northeastern region (New England division); two states in Midwestern region (East North Central Division and West North Central division), and one state in the western region (Mountain division) were included due to contact information accessibility and as a means of gathering information from a broader demographic of physical therapists and physical therapist assistants with varying degrees of experience and event exposures. Respondents also were encouraged to forward the survey link to colleagues in other states. Physical therapists and physical therapist assistants registered as active licensees in the U.S. were eligible to participate. All other professionals were excluded from this research. The survey was prefaced with a cover letter approved by the affiliated university’s institutional review board (IRB) specifying that survey continuation beyond the preface indicated the assumption of consent.

Instrument

A four part questionnaire (Appendix A) was developed based on a comprehensive review of the literature as well as the adaptation of additional items from other published

instruments.23,24 Items and content were developed by a collaborative team of physical therapists, and the instrument was validated by a content expert (a regional Public Health Preparedness Coordinator with Mass Fatality Management responsibilities) and four construct experts with experience in survey design. After expert review, the electronic version of the survey was piloted by nine clinicians to test ease of completion. The pilot revealed no major changes to the survey necessary.

Section 1 consisted of nine items fielding specific demographic characteristics from respondents. Section 2 consisted of nine items specific to education, practice setting, experience, and expertise in a PHE disaster response, including a question specific to physical therapist service delivery in the ED. Section 3 involved twenty-four attitude statements about confidence and skills/abilities to treat common injuries sustained in disasters and an additional item gauging perceived levels of preparedness. These attitude statements utilized a 4-point Likert scale ranging from strongly disagree (value = 1), disagree, agree, to strongly agree (value = 4). Section 4 of the instrument consisted of one item specific to participation commitment and willingness to assume risk of involvement in a disaster setting. This section’s “commitment to participate” item utilized a 4-point Likert scale ranging from strongly committed (value = 4), committed, reluctant to commit, and unwilling to commit (value = 1).

Procedure

The study design was cross-sectional. The non-experimental survey approach was selected for its ability to access a broad population of physical therapists and physical therapist assistants in various geographic locations of the U.S. The materials needed to complete this survey included access to the internet. The researchers’ affiliated university IRB approved the study. An invitation to participate, including the link to access the survey, was sent to the acquired email addresses of licensed physical therapists

and physical therapist assistants in four of the selected six states, and the online link was provided to members of a professional organization’s newsletter in two states. The authors also provided an opportunity for the respondents to join a raffle drawing awarding six participants with $25 gift cards to an online shopping network if they chose to participate. This strategy was utilized to motivate prospective respondents to participate in this survey research.

Data Analysis

Descriptive statistics, frequencies, and cross tabulations were used to profile demographic data. To compare groups, age was collapsed into five categories (20-29 years, 30-39 years, 40-49 years, 50-59 years and 60 or older), and practice experience was collapsed into six categories (0-5 years, 6-10 years, 11-15 years, 16-20 years, 21-25 years and 26+ years). Means and frequencies were used to understand levels of experience, confidence, preparedness, and commitment as well as incidence of the PHE care provision.

Independent t-tests (α = .05) were employed to look at binary between-group differences in confidence while working with victims of a disaster with/without American Board of Physical Therapy Specialties (ABPTS) certification and with/without disaster response specific training and experience. A one-way ANOVA (α = 0.05) was used to analyze group (e.g., primary practice setting, age group, and practice experience group) differences in working with victims of disaster. A least significant difference (LSD) post hoc analysis was used for detected differences. Pearson’s correlation was used to understand the relationship between confidence in responding to PHEs and a commitment to registering with the Medical Reserve Corps (MRC). All analyses were performed using IBM Statistical Package for Social Sciences (SPSS) Version 24.®

ResultsSubjects

Survey respondents included 395 licensed physical therapists and 12 (2.9%) physical



therapist assistants from 35 of 50 states within the U.S. (Table 1). Analyses were completed for physical therapists alone due to the low physical therapist assistant response rate. The mean number of years of practice was 19.95 + 11.46 years (range = 1 to 45), and their mean age was 45.79 + 11.41 years (range 26 to 72). Approximately 18.2% (n = 72) of respondents reported possessing a current ABPTS clinical specialization. Respondents reported a variety of primary practice areas, with the greatest numbers practicing primarily in a health system or hospital-based outpatient facility or clinic (19.4%, n = 77) or private outpatient office of group practice (19.0%, n = 75; Table 2). Twenty percent (19.5%; n = 77) of respondents reported they provided physical therapist services in the ED while eight percent (8.1%; n = 32) reported they were volunteers with Community Emergency Response Training (CERT). CERT is a program that trains indivdiuals to respond to hazards that threaten their communities and support overwhelmed first responders after a major disaster.

Training and Experience with Emergency Response

Many respondents reported having encountered the need to use life-saving skills, with 37.2% (n = 147) using these skills at work, 27.1% (n = 107) in the community, and 17.2% (n = 68) in both work and community environments. Among those who reported using life-saving skills at work, 97.3% reported feeling confidence in their ability to take vital signs in a disaster. In contrast, 89.9% of those who had not encountered the need to use life-saving skills at work felt the same levels of confidence in taking vital signs in a disaster. Among those who had encountered the need to use life-saving skills at work, 40.8% (n = 60) agreed or strongly agreed that their education was adequate in teaching them emergency response skills. In contrast, of those who had not encountered such need to use life-saving skills at work, 25.4% agreed or strongly agreed that their education was adequate.

Respondents reported their experience during or after the emergency phase, or both, with a variety of PHEs (Table

3), including biologic (e.g., epidemic, pandemic), cataclysmic geophysical (e.g., earthquake, volcano), climatologic (e.g., extreme temperatures, drought, wildfire), human action incidence leading to mass casualties (e.g., mass shooting, terror attack), hydrologic (e.g., flood), meteorological (e.g., tsunamis, hurricanes, tornadoes), or transportation incidence (e.g., car crashes, plane crashes, train wrecks). Most respondents (82.4%; n = 233) reported some exposure to working with victims of a transportation incident. The least frequently reported encounter was with hydrological events, with 15.7% (n = 62) reporting some exposure toward treating victims of these types of disasters.

PHE Confidence in Emergency Response Skills and Abilities and PHE Response Preparedness

Training and experience of many types showed a positive effect on confidence in the ability to work with victims of disaster (Table 4). In fact, all types of disaster response training surveyed showed respondents with higher levels of confidence, with the exception of CPR/

Region of the United States Number of ReportingRespondents

% ReportingRespondents

New England [4 of 6 states with at least 1 response]• Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut [n = 15] 15 3.8%

Middle Atlantic [3 of 3 states with at least 1 response]• New York, Pennsylvania, New Jersey [n = 13] 13 3.3%

Midwest [8 of 12 states with at least 1 response]• East North Central: Wisconsin, Michigan, Illinois, Indiana, Ohio [n = 136]• West North Central: North Dakota, South Dakota, Nebraska, Kansas, • Minnesota, Iowa, Missouri [n = 36]

172 43.5%

South [13 of 16 states with at least 1 response]• South Atlantic: Delaware, Maryland, Virginia, West Virginia, North Carolina, • South Carolina, Georgia, Florida [n = 147]• East South Central: Kentucky, Tennessee, Mississippi, Alabama [n = 6]• West South Central: Oklahoma, Texas, Arkansas, Louisiana [n = 5]

158 40.0%

West [7 of 13 states with at least 1 response]• Mountain: Idaho, Montana, Wyoming, Nevada, Utah, Colorado, Arizona, • New Mexico [n = 28]• Pacific: Alaska, Washington, Oregon, California, Hawaii [n = 9]

37 9.4%

Table 1. Regions within which Respondents Practice



3), including biologic (e.g., epidemic, pandemic), cataclysmic geophysical (e.g., earthquake, volcano), climatologic (e.g., extreme temperatures, drought, wildfire), human action incidence leading to mass casualties (e.g., mass shooting, terror attack), hydrologic (e.g., flood), meteorological (e.g., tsunamis, hurricanes, tornadoes), or transportation incidence (e.g., car crashes, plane crashes, train wrecks). Most respondents (82.4%; n = 233) reported some exposure to working with victims of a transportation incident. The least frequently reported encounter was with hydrological events, with 15.7% (n = 62) reporting some exposure toward treating victims of these types of disasters.

PHE Confidence in Emergency Response Skills and Abilities and PHE Response Preparedness

Training and experience of many types showed a positive effect on confidence in the ability to work with victims of disaster (Table 4). In fact, all types of disaster response training surveyed showed respondents with higher levels of confidence, with the exception of CPR/

Region of the United States Number of ReportingRespondents

% ReportingRespondents

New England [4 of 6 states with at least 1 response]• Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut [n = 15] 15 3.8%

Middle Atlantic [3 of 3 states with at least 1 response]• New York, Pennsylvania, New Jersey [n = 13] 13 3.3%

Midwest [8 of 12 states with at least 1 response]• East North Central: Wisconsin, Michigan, Illinois, Indiana, Ohio [n = 136]• West North Central: North Dakota, South Dakota, Nebraska, Kansas, • Minnesota, Iowa, Missouri [n = 36]

172 43.5%

South [13 of 16 states with at least 1 response]• South Atlantic: Delaware, Maryland, Virginia, West Virginia, North Carolina, • South Carolina, Georgia, Florida [n = 147]• East South Central: Kentucky, Tennessee, Mississippi, Alabama [n = 6]• West South Central: Oklahoma, Texas, Arkansas, Louisiana [n = 5]

158 40.0%

West [7 of 13 states with at least 1 response]• Mountain: Idaho, Montana, Wyoming, Nevada, Utah, Colorado, Arizona, • New Mexico [n = 28]• Pacific: Alaska, Washington, Oregon, California, Hawaii [n = 9]

37 9.4%

Table 1. Regions within which Respondents Practice

BLS. The results specific to CPR/BLS can be explained in that the sample of physical therapists who were not trained was disproportionately smaller (n = 3) than that of those who were trained (n = 392). Large effects were observed for those with CERT training and those with experience providing sports sideline coverage.

Respondents with current ABPTS clinical specialization were no more confident than their counterparts without clinical specialization in their ability to work with victims of a disaster (p = .822). Respondents identifying as male were more confident in their ability to work with victims of disaster (p < .001). Between-group differences were detected in levels of confidence in the ability to work with victims of disaster by primary practice area (p = .043). Those working in inpatient subacute rehabilitation hospital settings and those in acute care hospitals or critical care access settings reported levels of agreement significantly greater than those in outpatient clinics (whether health-system based or private) and pediatric educational settings when asked if they were confident in their ability to work with victims of disaster.

Mean agreement values are reported by practice setting in Table 5. Respondents reported the greatest confidence in responding to those with contusions (Table 6). The lowest level of confidence was reported with management of burns.

Neither age (p = .547) nor years of practice experience (p = .661) were differentiating factors in determining whether respondents believed that physical therapists have experience that can be utilized in disaster relief and recovery. Similarly, neither age (p = .429) nor practice experience (p = .836) were differentiating factors in determining whether physical therapists should be included in disaster planning policy development (Table 7). Of further interest, there was a significant correlation (r = 0.801; p < .001) between those who agreed that physical therapists have expertise that can be utilized in disaster relief and recovery and those who agreed that physical therapists should be included in disaster planning policy development.

Table 8 depicts respondent preparedness to participate by type of PHE and response timing. Respondents were more prepared

to respond in clinic or hospital than on-scene for all PHE types. The greatest level of preparedness was associated with roadside accident. Respondents were least prepared to respond to a biologic event.

Commitment and Willingness to Respond

Nearly half (48.4%, n = 191) of all respondents reported they were either strongly committed or committed to responding to a PHE on a local or regional level. The remaining sample reported they were reluctant to commit (45.6%, n = 180) or unwilling to commit (3.8%, n = 15). Nearly 78% of respondents believed that first aid training should be a required certification for licensure, with renewal required every two years.

DiscussionThis study examined beliefs among physical therapists about response readiness and perceived self-efficacy among those tasked with employing specific skills and knowledge on field or in facility in response to a PHE. An understanding of these attitudes, beliefs, and behaviors and their relationships to training and experience


n (%)Academic institution (post-secondary) 23 (5.8%)

Acute care hospital or Critical Care Access 62 (15.7%)

Health and wellness facility 3 (0.8%)

Health system or hospital-based outpatient facility or clinic 77 (19.5%)

Home healthcare 58 (14.7%)

Military or VA 8 (2.0%)

Pediatric educational 17 (4.3%)

Pediatric medical or pediatric mix 18 (4.6%)

Private outpatient office or group practice 75 (19.0%)

Pro-elite sport 2 (0.5%)

Rural mixed caseload 4 (1.0%)

SNF/ECF/ICF/LTAC 34 (8.6%)

Subacute rehab hospital (inpatient) 14 (3.5%)

Total 395

Table 2. Respondent Primary Practice Areas


During Emergency

Phase

After Emergency

Phase

During & After Emergency

PhaseNo Experience

Biologic 10 (2.5%) 129 (32.7%) 48 (12.2%) 208 (52.7%)Cataclysmic geophysical 10 (2.5%) 109 (27.6%) 61 (15.4%) 215 (54.4%)Climatologic 13 (3.3%) 111 (28.1%) 57 (14.4%) 214 (54.2%)Human action incidence 9 (2.3%) 123 (31.1%) 68 (17.2%) 195 (49.4%)Hydrologic 9 (2.3%) 107 (27.1%) 56 (14.2%) 223 (56.5%)Meteorological 9 (2.3%) 121 (30.6%) 95 (24.1%) 170 (43.0%)Transportation incident 8 (2.0%) 157 (39.7%) 78 (19.7%) 152 (38.5%)

Table 3. Experience with Disasters

can be used to improve physical therapist utilization and preparedness. The findings in this study may also be used to advocate for recognition of physical therapists as PHE responders at local, state, national, and international levels and to highlight involvement barriers associated with a lack of curriculum and training uniformity.

The current study lends to the literature its findings that disaster response specific training (i.e., first aid and MERT training) improves confidence to work with victims of

a PHE. Yet, just 31.1% of respondents agreed or strongly agreed that their education adequately taught them response skills. A large majority (77.2%) of respondents sought continued education, asserting that professionals should pursue biennial recertification of (agency non-specific) first aid training. These findings are in agreement with the work of Harrison and colleagues,16 who concluded that physical therapists need further training, including first aid certification, to improve confidence.

The results of this survey highlight professional barriers to initiatives by the disaster planning and policy community to utilize physical therapists during a PHE. Given the relationship between training and confidence, an argument can be made that the development of a PHE curriculum shaped by a minimal set of competencies should be made available to physical therapists with an interest in PHE response involvement. An integrative review by Jose and Dufrene25 looked for continuity in


Training or Experience? (n; M, SD)

t p d

Yes NoAdvanced Life Support Training 185; 2.941, .731 210; 2.600, .765 4.519 .000b .456Athletic Training Certificate 29; 3.000, .655 366; 2.740, .773 2.026 .051 .363Community Response Training (CERT) 58; 3.241, .572 337; 2.677, .767 6.575 .000b .834c

CPR or Basic Life Support (BLS) Training 392; 2.758, .767 3; 3.000, 1.000 - .419 .587 .272

Disaster Relief Training (Red Cross, etc) 99; 3.101, .562 296; 2.645, .794 6.247 .000b .663c

Emergency Preparedness 251; 2.451, .818 144; 2.936, .678 6.024 .000b .646c

Emergency Medical Services/ First Responder 97; 3.083, .702 298; 2.654, .760 5.109 .000b .586c

Medical Emergency Response Team 37; 3.215, .585 358; 2.721, .767 -3.162 .002b .574c

Emergency Department Physical Therapy Services 77; 2.974, .725 318; 2.708, .770 -2.859 .005b .356Sports Sideline Coverage 53; 3.215, .585 342; 2.684, .766 -6.205 .000b .823c

Table 4. Training vs. No-training Comparison of Responses to “I feel confident in my ability to work with victims of a disaster”a

a1=Strongly Disagree; 2=Disagree; 3=Agree; 4=Strongly Agree; bp < .05; c Medium (d = .5) or large (d = .8) effect


curricular approaches and competencies within undergraduate nursing education. Their work identified a lack of uniformity among approaches used, with didactic methods ranging from low to high fidelity simulations, virtual simulation, and live actors. With this in mind, early efforts toward defining competencies and curriculum should be cohesive and intentional and define a clear path for developing minimal competencies specific to the physical therapist as a member of the interprofessional response team.

Efforts toward designing PHE response curriculum and competencies must also be intentionally specific to PHE type. For example, while training, in general, has been shown to bolster a sense of readiness to respond for most PHEs, education alone may not improve the willingness of a healthcare provider to respond to a biologic epidemic or pandemic event.1 To illuminate this point, respondents in the current study showed a large confidence swing with this type of PHE from nearly 30% reporting preparedness to respond for on-scene triage to 70% reporting preparedness in a clinic or hospital setting. These differences in level

of preparedness may be explained by the nature of infectious risk associated with a biologic epidemic and access to personal protective equipment on-scene/field versus in clinic/hospital.

To better define the role of physical therapists in PHE management, future studies should scrutinize specific aspects of the physical therapist skill set that are well matched to the specifics of PHEs. Discovering this crucial information will assist physical therapists to hone these skills for competent delivery aside other members of the response team. The 2018 APTA House of Delegates session, RC 44-1826 charged the APTA to “identify the professional role of the [PT] and [PTA] in disaster preparation, response, and recovery. Further, that APTA promote the role of the PT and PTA to members and agencies that manage disasters, so that the expertise of PTs and PTAs can be utilized appropriately.” The support statement made reference to the role-ambiguity reported by others and bulleted opportunities within each phase of disaster relief for physical therapists to participate. Examples include contingency planning, equipment stockpiling, training and field exercises, wound triage, safe patient transport,

management of rescue worker injury, and planning and assessment of disaster relief shelters/stations for mobility and accessibility. Background papers report that the APTA is already working on engagement initiatives, has developed informational resources, and is exploring partnerships with public and private agencies.26

Limitations and Future Research

A finding of the current study showed that respondents in subacute rehabilitation hospitals, acute care hospitals, and critical care access sites were more confident in their skills to work with disaster victims compared to other practice settings. Nearly 20% of respondents also provided services in the ED. This high representation from those providing ED services may reveal a sample bias, as this survey may have specifically piqued the interest of those who work in the ED.

Additional sample bias is suggested by the number of respondents with 26 or more years of experience (n = 136) and by the number of respondents in the Midwest (n=172) and South (n = 158) regions of the U.S.. Given the evolution of physical therapist professional education and

During Emergency

Phase

After Emergency

Phase

During & After Emergency

PhaseNo Experience

Biologic 10 (2.5%) 129 (32.7%) 48 (12.2%) 208 (52.7%)Cataclysmic geophysical 10 (2.5%) 109 (27.6%) 61 (15.4%) 215 (54.4%)Climatologic 13 (3.3%) 111 (28.1%) 57 (14.4%) 214 (54.2%)Human action incidence 9 (2.3%) 123 (31.1%) 68 (17.2%) 195 (49.4%)Hydrologic 9 (2.3%) 107 (27.1%) 56 (14.2%) 223 (56.5%)Meteorological 9 (2.3%) 121 (30.6%) 95 (24.1%) 170 (43.0%)Transportation incident 8 (2.0%) 157 (39.7%) 78 (19.7%) 152 (38.5%)


Training or Experience? (n; M, SD)

t p d

Yes NoAdvanced Life Support Training 185; 2.941, .731 210; 2.600, .765 4.519 .000b .456Athletic Training Certificate 29; 3.000, .655 366; 2.740, .773 2.026 .051 .363Community Response Training (CERT) 58; 3.241, .572 337; 2.677, .767 6.575 .000b .834c

CPR or Basic Life Support (BLS) Training 392; 2.758, .767 3; 3.000, 1.000 - .419 .587 .272

Disaster Relief Training (Red Cross, etc) 99; 3.101, .562 296; 2.645, .794 6.247 .000b .663c

Emergency Preparedness 251; 2.451, .818 144; 2.936, .678 6.024 .000b .646c

Emergency Medical Services/ First Responder 97; 3.083, .702 298; 2.654, .760 5.109 .000b .586c

Medical Emergency Response Team 37; 3.215, .585 358; 2.721, .767 -3.162 .002b .574c

Emergency Department Physical Therapy Services 77; 2.974, .725 318; 2.708, .770 -2.859 .005b .356Sports Sideline Coverage 53; 3.215, .585 342; 2.684, .766 -6.205 .000b .823c

Mean (SD)a

Academic institution (post-secondary) 2.78 (0.85)Acute care hospital or Critical Care Access 2.95 (0.73)Health and wellness facility 2.33 (0.58)Health system or hospital-based outpatient facility or clinic 2.67 (0.77)

Home healthcare 2.91 (0.73)Military or VA 2.75 (0.46)Pediatric educational 2.53 (0.80)Pediatric medical or pediatric mix 2.78 (1.00)Private outpatient office or group practice 2.53 (0.83)Pro-elite sport 2.50 (0.71)Rural mixed caseload 2.75 (0.50)SNF/ECF/ICF/LTAC 2.79 (0.54)Subacute rehab hospital (inpatient) 3.21 (0.58)

Table 5. Level of Confidence in the Ability to Work with Victims of Disaster, by Primary Practice Area

a1=Strongly Disagree; 2=Disagree; 3=Agree; 4=Strongly Agree

a1=Strongly Disagree; 2=Disagree; 3=Agree; 4=Strongly Agree; bp < .05; c Medium (d = .5) or large (d = .8) effect


practice over the last four decades, as well as documented regional variations in practice, future studies should seek to obtain a more representative sample and investigate in more detail the influences of didactic education as well as residency and fellowship training on confidence in disaster response preparedness.

It should be noted that the attitudes surveyed were those of perceived readiness, which may be distinguished from actual readiness to respond. Future research should query those who have responded to a PHE to study, retrospectively, levels and predictors of actual readiness to respond.

ConclusionThis study found that physical therapists who have PHE-related certification and training (e.g., CERT training, disaster relief training) and work in settings where their emergency response skills are more likely utilized (e.g., sports sideline training, acute care experience, ED service provision) were more confident in working with victims of disaster following a PHE. Differences in confidence associated with field and facility responses, as well as with different types of trauma or exposure, may be explained by inexperience, lack of training, exclusion from planning phases, and poorly defined organizational roles. PHE curriculum and minimum competencies specific to physical therapists' unique contribution to the interprofessional response team should be articulated in an effort to clarify role ambiguity and bolster the knowledge and confidence of the physical therapist interested in response involvement before, during, and/or after a PHE. Additional research is needed to inform specific content areas, training methods and roles and responsibilities for physical therapists to play in interprofessional disaster response teams.

References1. Connor S. When and why healthcare personnel respond to a disaster: the state of science. Prehosp Disaster Med. 2014;29(3):270-274.

2. Below R, Wirtz A, Guha-Sapir D.

Disaster category classification and peril terminology for operational purposes. Common accord, Centre for Research on Epidemiology of Disasters (CRED) and Munich Reinsurance Company. Available at: https://www.cred.be/downloadFile.php?file=sites/default/files/DisCatClass_264.pdf. Published 2009. Accessed December 28, 2018.

3. Noe RS, Schnall AH, Wolkin AF, et al. Disaster-related injuries and illnesses treated by American Red Cross disaster health services during Hurricanes Gustav and Ike. South Med J. 2013;106(1):102-8.

4. Edgar D, Wood F, Goodwin-Walters A. Maintaining physical therapy standards in an emergency situation: solutions after the Bali bombing disaster. Burns. 2005;31:555-557.

5. Landry MD, O’Connell C, Tardif G, Burns A. Post-earthquake Haiti: The critical role for rehabilitation services following a humanitarian crisis. Disabil Rehabil. 2010;32:1616-8.

6. National Preparedness Goal. FEMA Web site. Available at: https://www.fema.gov/national-preparedness-goal. Updated August 9, 2017. Accessed July 12, 2018.

7. United Nations International Strategy for Disaster Risk Reduction. Natural disasters and sustainable development: understanding the links between development, environment and natural disasters. Background Paper No. 5. Geneva: United Nations Department of Economic and Social Affairs. Available at: https://reliefweb.int/sites/reliefweb.int/files/resources CFEEBC994F3E642AC1256CA2005BD 30B-isdr-natural-dec01.pdf. Published: 2001. Accessed December 28, 2018.

8. Noji EK. Public health issues in disasters. Crit Care Med. 2005;33:S29-33.

9. Raissi GR. Earthquakes and rehabilitation needs: Experiences from Bam, Iran. J Spinal Cord Med. 2007;30:369-72.

10. Mills J, Gosney J, Stephenson F, Skelton

P, Norton I, Scherrer V, Jacquemin G, Rau B. Development and Implementation of the World Health Organization Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation. PLOS Currents Disasters. 2018 Jul 9 . Edition 1. doi: 10.1371/currents.dis.76fd9ebfd8689469452cc8c0c0d7cdce.Khan F, Amatya B, Gosney J, Rathore F, Burkle F. Medical rehabilitation in natural disasters: a review. Arch Phys Med Rehabil. 2015; 96:1709-1727.

11. Nepal Physiotherapy Association. The role of physical therapists in the medical response team following a natural disaster: Our experience in Nepal. J Orthop Sports Phys Ther. 2015;45(9):644-646.

12. Nixon S, Cleaver S, Stevens M, Hard J, Landry M. The role of physical therapists in natural disasters: what can we learn from the earthquake in Haiti? Physiother Canada. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909863/. Published 2010. Accessed July 12, 2018.

13. Mulligan H, Smith C, Ferdinand S. How did the Canterbury earthquakes affect physiotherapists and physiotherapy services? A qualitative study. Physiother Res Int. 2015; 20:60-68.

14. Waldrop S. Physical therapists vital role in disaster management. APTA Website. PT Magazine. 2002;10(6):1-5.

15. Harrison R. Preliminary investigation into the role of physiotherapists in disaster response. Prehosp Disaster Med. 2007;22(5):462-466.

16. American Physical Therapy Association. Code of ethics for the physical therapist. Available at: https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Ethics/CodeofEthics.pdf. Accessed July 12, 2018.

17. Association of Public Health Nurses Public Health Preparedness Committee. The role of public health nurse in disaster preparedness, response and recovery: a position paper. Available at: http://www.achne.org/f i les/public/APHN_RoleOfPHNinDisasterPRR_FINALJan14.



P, Norton I, Scherrer V, Jacquemin G, Rau B. Development and Implementation of the World Health Organization Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation. PLOS Currents Disasters. 2018 Jul 9 . Edition 1. doi: 10.1371/currents.dis.76fd9ebfd8689469452cc8c0c0d7cdce.Khan F, Amatya B, Gosney J, Rathore F, Burkle F. Medical rehabilitation in natural disasters: a review. Arch Phys Med Rehabil. 2015; 96:1709-1727.

11. Nepal Physiotherapy Association. The role of physical therapists in the medical response team following a natural disaster: Our experience in Nepal. J Orthop Sports Phys Ther. 2015;45(9):644-646.

12. Nixon S, Cleaver S, Stevens M, Hard J, Landry M. The role of physical therapists in natural disasters: what can we learn from the earthquake in Haiti? Physiother Canada. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909863/. Published 2010. Accessed July 12, 2018.

13. Mulligan H, Smith C, Ferdinand S. How did the Canterbury earthquakes affect physiotherapists and physiotherapy services? A qualitative study. Physiother Res Int. 2015; 20:60-68.

14. Waldrop S. Physical therapists vital role in disaster management. APTA Website. PT Magazine. 2002;10(6):1-5.

15. Harrison R. Preliminary investigation into the role of physiotherapists in disaster response. Prehosp Disaster Med. 2007;22(5):462-466.

16. American Physical Therapy Association. Code of ethics for the physical therapist. Available at: https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Ethics/CodeofEthics.pdf. Accessed July 12, 2018.

17. Association of Public Health Nurses Public Health Preparedness Committee. The role of public health nurse in disaster preparedness, response and recovery: a position paper. Available at: http://www.achne.org/f i les/public/APHN_RoleOfPHNinDisasterPRR_FINALJan14.


Mean (SD)a

I feel confident in my ability to work with traumatic fractures. 2.87 (0.80)I feel confident in my ability to work with impairments resulting from traumatic brain injuries. 2.99 (0.80)I feel confident in my ability to work with impairments resulting from spinal cord injuries. 2.89 (0.78)I feel confident in my ability to manage burns. 2.37 (0.86)

I feel confident in my ability to work with wound care and lacerations. 2.73 (0.84)I feel confident in my ability to work with contusions. 3.18 (0.66)I feel confident in my ability to work with amputations. 3.03 (0.81)I feel confident in my ability to work with peripheral nerve injuries. 3.14 (0.62)I feel confident in my ability to work with crush injuries. 2.72 (0.76)

Table 6. Preparedness to Participate within Scope of Medical Practice


Belief that Physical therapists Have Useful Expertise for PHE

Belief that Physical Therapists Should be Included in Disaster Planning Policy Development

Mean (SD)a Mean (SD)a

Practice Experience, in years1-5 years (n=52) 3.10 (0.66) 3.08 (0.68)6-10 years (n=57) 3.15 (0.62) 3.05 (0.74)11-15 years (n=39) 3.23 (0.67) 3.15 (0.67)16-20 years (n=61) 3.26 (0.63) 3.21 (0.55)21-25 years (n=52) 3.19 (0.63) 3.12 (0.62)26+ (n=134) 3.22 (0.59) 3.14 (0.64)Age, in years20-29 years (n=33) 3.06 (0.75) 3.06 (0.75)30-39 years (n=98) 3.16 (0.60) 3.06 (0.67)40-49 years (n=100) 3.25 (0.61) 3.18 (0.58)50-59 years (n=109) 3.19 (0.65) 3.11 (0.69)60 years or older (n=55) 3.25 (0.55) 3.24 (0.58)

Table 7. Attitudes toward PT Involvement in Public Health Event Responses, by Experience and Age



If I were deployed as a medical professional, I would be prepared to participate (within my scope of medical practice) ...

Response Timing [Mean (SD)a]... in the on-scene triage care

following the event.... in the clinic or hospital

response following the event.Biologic (e.g., epidemic, pandemic) 2.18 (0.79) 2.76 (0.75)Cataclysmic geophysical (e.g., earthquake, volcano) 2.35 (0.81) 2.99 (0.68)Climatologic (e.g., extreme temperatures, drought, wildfire) 2.36 (0.79) 2.94 (0.68)Human-action (e.g., mass shooting, terror attack) 2.36 (0.82) 2.95 (0.70)Hydrologic (e.g., flood) 2.38 (0.81) 2.98 (0.67)Meteorological (e.g., tsunami, hurricane, tornado) 2.42 (0.84) 3.01 (0.67)Roadside accident 2.58 (0.75) 3.07 (0.61)

Table 8. Preparedness to Participate, by Public Health Event Type and Timing


pdf. Published 2013. Accessed December 28, 2018.

18. World Confederation for Physical Therapy WCPT Report: The role of physical therapists in disaster management. Available at: https://www.wcpt.org/sites/wcpt.org/files/files/resources/reports/WCPT_DisasterManagementReport_FINAL_March2016.pdf. Published 2016. Accessed December 28, 2018.

19. Rathore FA, Farooq F, Muzammil S, New PW, et al. Spinal cord injury management and rehabilitation: Highlights and shortcomings from the 2005 earthquake in Pakistan. Arch Phys Med Rehabil. 2008;89:579-85.

20. Christman S, Heinrich M. Physical therapy’s role in disaster management. Fed Phys Ther Section Newsletter. Available at: http://federalpt.org/pdfs/newsletter/FPTS-

Summer-2018-newsletter.pdf. Published Summer 2018. Accessed December 28, 2018.

21. Ogedegbe C, Nyirenda T, DelMoro G, Yamin E, Feldman J. Healthcare workers and disaster preparedness: barriers to and facilitators of willingness to respond. J Emerg Med. 2012;5(29):1-9.

22. Dawson GC. Years of clinical experience and therapist professional development: A literature review. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy. November 2017. doi:10.1007/s10879-017-9373-8.

23. Tavan H, Menati W, Azadi A, Sayehmiri K, Sahebi A. Development and validation of a questionnaire to measure Iranian nurses’ knowledge, attitude and practice regarding disaster preparedness. J

Clin Diagn Res. 2016;10(8):6-9.

24. Jose MM, Dufrene C. Educational competencies and technologies for disaster preparedness in undergraduate nursing education: an integrative review. Nurse Educ Today. 2014;34(4):543-551. doi: 10.1016/j.nedt.2013.07.021.

25. American Physical Therapy Association House of Delegates. RC 44-18 (2018).

26. Bozkurt M, Ocquder A, Turktas U, Erdem M. The evaluation of trauma patients in Turkish Red Crescent Field Hospital following the Pakistan earthquake in 2005. Injury. 2007;38(3):290-297



If I were deployed as a medical professional, I would be prepared to participate (within my scope of medical practice) ...

Response Timing [Mean (SD)a]... in the on-scene triage care

following the event.... in the clinic or hospital

response following the event.Biologic (e.g., epidemic, pandemic) 2.18 (0.79) 2.76 (0.75)Cataclysmic geophysical (e.g., earthquake, volcano) 2.35 (0.81) 2.99 (0.68)Climatologic (e.g., extreme temperatures, drought, wildfire) 2.36 (0.79) 2.94 (0.68)Human-action (e.g., mass shooting, terror attack) 2.36 (0.82) 2.95 (0.70)Hydrologic (e.g., flood) 2.38 (0.81) 2.98 (0.67)Meteorological (e.g., tsunami, hurricane, tornado) 2.42 (0.84) 3.01 (0.67)Roadside accident 2.58 (0.75) 3.07 (0.61)

Table 8. Preparedness to Participate, by Public Health Event Type and Timing


Appendix A: Public Health Emergency Response Preparedness among Physical Therapists and Physical Therapist Assistants

Section 1: Demographic Information 1. What is your professional designation?

ļ Physical Therapist (PT) Licensed to Practice in the USA ļ Physical Therapist Assistant (PTA) Licensed to Practice in the

USA ļ Neither a PT nor a PTA

2. How many years have you practiced as a physical therapist (PT) or physical therapist assistant (PTA)? Please respond by rounding to half years (i.e., 1.0, 3.5, 30.5, etc).

3. What is your highest achieved clinical PT/PTA degree earned? ļ Associate’s Degree ļ Certificate ļ Baccalaureate Degree ļ Master’s Degree ļ Clinical Doctorate in Physical Therapy (DPT; entry level or

transitional) ļ PhD

4. Select any of the below specialty areas for which you possess American Board of Physical Therapy Specialties (ABPTS) board certification.

☐ Cardiovascular and Pulmonary ☐ Clinical Electrophysiology ☐ Geriatrics ☐ Neurology ☐ Oncology ☐ Orthopaedics ☐ Pediatrics ☐ Sports ☐ Women’s Health ☐ I do not possess board certification

5. Provide information about any additional non-ABPTS certifications you hold.

6. Which of the following practice environments BEST describes your PRIMARY area of practice?

ļ Academic institution (post-secondary) ļ Acute care hospital ļ Critical care access ļ Health and wellness facility ļ Health system or hospital based outpatient facility or clinic ļ Home healthcare ļ Military or VA ļ Pediatric educational ļ Pediatric medical ļ Pediatric mix ļ Private outpatient office or group practice ļ Pro-elite sport ļ Research center ļ Rural mixed caseload ļ SNF/ECF/ICF/LTAC ļ Subacute rehab hospital (inpatient)

7. With which gender do you identify?• Female• Male• Do not wish to identify

8. What is your age in years (enter number in full years, i.e., 32, 45, 64).

9. Within which state do you practice the MAJORITY of the time? [A drop-down selection of all U.S. states is provided in the original survey]

0 = Single Select ☐ = Multiple Select



Section 2: Training and Experience with Emergency Response10. Select the option that best describes the provision of your care/expertise as a PT/PTA in any of the below types of major disasters, public health events, or emergency situations.

11. Select any of the below entit(ies) responsible for your training in any of the below emergency response trainings. You may select more than one entity for each type of training.

12. Are you a member of a Medical Emergency Response Team (MERT) within your facility? (Yes or No option)

13. Are you a Community Emergency Response Team (CERT) volunteer? (Yes or No option)

14. Do you provide physical therapist services in the emergency room? (Yes or No option)

15. Do you provide sideline coverage at sporting events? (Yes or No option)

16. Have you encountered the need to use life-saving skills at work? (Yes or No option)

17. Have you encountered the need to use life-saving skills while in the community? (Yes or No option)

18. Have you registered as a medical staff volunteer with the Medical Reserve Corp (MRC)? (Yes or No option)


Provision DURING

emergency phase (i.e., on site or at

the scene)

Provision AFTERemergency phase

(i.e., within medical facilities;

rehabilitation)

Provision DURING

AND AFTER emergency

phase

NO provision of care during this

type of majordisaster or PHE

Cataclysmic geophysical (i.e., earthquake, volcano) 0 0 0 0Meteorologic (i.e., tsunamis, hurricanes, tornados) 0 0 0 0Hydrologic (i.e., flood) 0 0 0 0Climatologic (i.e., extreme temperatures, drought, wildfire) 0 0 0 0

Biologic (i.e., epidemic, pandemic) 0 0 0 0Human-action incidences leading to mass casualties (i.e., mass shooting, terror attack) 0 0 0 0

Transportation incident (i.e., car crashes, plane crashes, train wrecks 0 0 0 0

PT School Employer Self-Initiated I do not have this type of training

Advanced Life Support Training ☐ ☐ ☐ ☐Athletic Training Certificate ☐ ☐ ☐ ☐Community Response Training (CERT) ☐ ☐ ☐ ☐CPR or Basic Life Support (BLS) Training ☐ ☐ ☐ ☐Disaster Relief Training (Red Cross, etc) ☐ ☐ ☐ ☐Emergency Preparedness ☐ ☐ ☐ ☐Emergency Medical Services/ First Responder ☐ ☐ ☐ ☐



Section 3: Perceived Confidence and Preparedness in Emergency Response Skills and Abilities19. To what extent do you agree with the below statements?

Strongly Disagree Disagree Agree Strongly

AgreeI feel confident in my ability to work with victims of a disaster. 0 0 0 0I feel confident in my ability to work with traumatic fractures 0 0 0 0I feel confident in my ability to work with impairments resulting from traumatic brain injuries. 0 0 0 0

I feel confident in my ability to work with impairments resulting from spinal cord injuries. 0 0 0 0

I feel confident in my ability to manage burns. 0 0 0 0I feel confident in my ability to work with wound care and lacerations. 0 0 0 0I feel confident in my ability to work with contusions. 0 0 0 0I feel confident in my ability to work with amputations. 0 0 0 0I feel confident in my ability to work with peripheral nerve injuries. 0 0 0 0I feel confident in my ability to work with crush injuries. 0 0 0 0I feel confident in my ability to triage patients in a disaster. 0 0 0 0I feel confident in my ability to take vitals in a disaster. 0 0 0 0I feel confident in my ability to work as part of a multidisciplinary team in disaster response. 0 0 0 0

I feel confident in my bracing/casting abilities. 0 0 0 0I feel confident in my wheelchair fitting abilities. 0 0 0 0I feel confident in my assistive device fitting/prescription abilities. 0 0 0 0I feel confident in my ability to mobilize patients in a disaster setting. 0 0 0 0I feel confident in my ability to triage and treat burns 0 0 0 0I feel confident in my ability to triage and treat wounds. 0 0 0 0I feel confident in my ability to deal with the psychological impact of disaster relief and recovery. 0 0 0 0

I feel my education was adequate for teaching me emergency response skills. 0 0 0 0

I believe that First Aid training should be a required certification for PT licensure that is renewed every two years like BLS CPR. 0 0 0 0

I believe PTs have expertise that can be utilized in disaster relief and recovery. 0 0 0 0

I believe PTs should be included in disaster planning policy development. 0 0 0 0



19. Medical personnel who are registered to be activated in the event of a public health event may be deployed to participate in (1) on-scene triage care within their scope of medical practice and (2) clinic or hospital responses. To what extent do you agree with the below statements?

If I were deployed as a medical professional, I would be prepared to participate (within my scope of medical practice)...

Section 4: Commitment and Willingness to Respond21. The Medical Reserve Corps (MRC) is a national network of volunteers, organized locally to improve the health and safety of their communities (https://mrc.hhs.gov/HomePage). This registry of medical professionals provides communities with a list of professional volunteers willing to participate in organized medical responses to emergencies and public health events.

Which of the below statements describes your level of commitment to respond to a Public Health Event/Disaster? — Strongly Committed: I would register with the MRC (or similar agency) and offer personal resources (i.e., time, travel expenses, etc.)

to respond to a PHE nationally or internationally if necessary. — Committed: I would register with the MRC (or similar agency) and offer personal resources (i.e., time, travel expenses, etc.) to

respond to a PHE on a local or regional level if necessary. — Reluctant to Commit: I am not likely to make efforts to register with the MRC (or similar agency) and would take no personal

initiatives beyond my employment responsibilities to involve myself in PHE response. — Unwilling to Commit: I would not offer my expertise in the event of a PHE or disaster.


Agreein the on-scene triage care following a Cataclysmic geophysical (i.e., earthquake, volcano) event. 0 0 0 0

in the clinic or hospital response following a Cataclysmic geophysical (i.e., earthquake, volcano) event. 0 0 0 0

in the on-scene triage care following a Meteorologic (i.e., tsunamis, hurricanes, tornadoes) event. 0 0 0 0

in the clinic or hospital response following a Meteorologic (i.e., tsunamis, hurricanes, tornadoes) event. 0 0 0 0

in the on-scene triage care following a Hydrologic (i.e., flood) event. 0 0 0 0in the clinic or hospital response following a Hydrologic (i.e., flood) event. 0 0 0 0

in the on-scene triage care following a Climatologic (i.e., extreme temperatures, drought, wildfire) event. 0 0 0 0

in the clinic or hospital response following a Climatologic (i.e., extreme temperatures, drought, wildfire) event. 0 0 0 0

in the on-scene triage care following a Biologic (i.e., epidemic, pandemic) event. 0 0 0 0

... in the clinic or hospital response following a Biologic (i.e., epidemic, pandemic) event. 0 0 0 0

in the on-scene triage care following a human-action incidence leading to mass casualties (i.e., mass shooting, terror attack) event. 0 0 0 0

in the clinic or hospital response following a human-action incidence leading to mass casualties (i.e., mass shooting, terror attack) event.

0 0 0 0

in the on-scene triage care following a roadside accident. 0 0 0 0in the clinic or hospital response following a roadside accident. 0 0 0 0

Nominate a Colleague at aptahpa.org/awardsby Nov. 15

Physical Therapy Journal of Policy, Administration and Leadership Vol 19 Issue 1


Agreein the on-scene triage care following a Cataclysmic geophysical (i.e., earthquake, volcano) event. 0 0 0 0

in the clinic or hospital response following a Cataclysmic geophysical (i.e., earthquake, volcano) event. 0 0 0 0

in the on-scene triage care following a Meteorologic (i.e., tsunamis, hurricanes, tornadoes) event. 0 0 0 0

in the clinic or hospital response following a Meteorologic (i.e., tsunamis, hurricanes, tornadoes) event. 0 0 0 0

in the on-scene triage care following a Hydrologic (i.e., flood) event. 0 0 0 0in the clinic or hospital response following a Hydrologic (i.e., flood) event. 0 0 0 0

in the on-scene triage care following a Climatologic (i.e., extreme temperatures, drought, wildfire) event. 0 0 0 0

in the clinic or hospital response following a Climatologic (i.e., extreme temperatures, drought, wildfire) event. 0 0 0 0

in the on-scene triage care following a Biologic (i.e., epidemic, pandemic) event. 0 0 0 0

... in the clinic or hospital response following a Biologic (i.e., epidemic, pandemic) event. 0 0 0 0

in the on-scene triage care following a human-action incidence leading to mass casualties (i.e., mass shooting, terror attack) event. 0 0 0 0

in the clinic or hospital response following a human-action incidence leading to mass casualties (i.e., mass shooting, terror attack) event.

0 0 0 0

in the on-scene triage care following a roadside accident. 0 0 0 0in the clinic or hospital response following a roadside accident. 0 0 0 0

HPA THE CATALYST AWARDSNOMINATIONS OPEN MAY 2019

R. Charles Harker, Esq,Policy Maker Award

LAMPLighter Award

Dr. Ronnie Leavitt Award for Leadership in the Promotion of Social Responsibility in Physical Therapy

HPA The Catalyst Technologyand Innovation Award

2019 AwardeeCelia Pechak, PT, PhD

2019 AwardeeLinda John, PT

2019 AwardeeBeth Sarfaty, PT, MBA 2019 Awardee

Matt Elrod, PT, DPT, MEd, NCS

Nominate a Colleague at aptahpa.org/awardsby Nov. 15

HPA The Catalyst has several awards to honor and acknowledge members who have committed their careers and lives to enhancing physical therapy practice and its access. Honor those special physical therapy professionals in the Section by nominating them for a 2020 award. Nominations open in May; start thinking about your nomination today! Visit

the HPA The Catalyst website to learn about each award and nomination criteria.

Vol 19 Issue 1 Physical Therapy Journal of Policy, Administration and Leadership22

ABSTRACT

Physical Therapy Journal of Policy, Administration and Leadership Vol 19 Issue 1

The following abstract is the winning platform presentation from the

Combined Sections Meeting (CSM) 2019 HPA The Catalyst Platform

Competition in Washington, D.C. Be sure to attend the HPA The Catalyst

platform presentations at CSM 2020 Feb. 12-15, 2020, in Denver, CO.

Purpose/Hypothesis. Wellness programs that promote physical activity are emerging as cost-effective strategies for chronic disease management in older adults. Recently, a large randomized controlled trial established the effectiveness of the On the Move (OTM) community-based exercise program to improve walking. Focused on the timing and coordination of walking, OTM improved walking speed and distance in community-dwelling older adults, more than a seated group exercise program commonly available in the community. However, OTM’s impact on incident falls, emergency department visits, and hospitalizations is unclear. We hypothesized that, compared to the usual-care group program, participation in OTM would reduce the risk of these adverse health outcomes over a 12-month follow-up period.

Number of Subjects. Older adults (≥65 years), who participated in the original OTM trial, were included in this study if they were 1) in a program taught by research staff and 2) completed ≥1 monthly follow-up phone call (n=248).

Materials/Methods. This cluster-randomized, single-blind intervention trial compared the effectiveness of OTM, a group exercise program that focused on motor learning of walking, against a conventional, seated group exercise program, focused on seated strength, endurance, and flexibility exercises (i.e. ‘usual-care’. Thirty-two independent living facilities, senior apartment buildings, and senior centers participated. Each intervention arm met for 50 minutes/session, 2 sessions/week, for 12 weeks. Self-reported incidence of falling, emergency department-use, and hospitalization during monthly automated phone calls in the 12 months following intervention completion. Generalized estimating equations models, which accounted for clustering, were used to analyze the risk of incurring each outcome, given intervention arm assignment. Models were adjusted for the number of classes attended, as this value was significantly different between intervention arms. Adjusted odds ratios (OR) were obtained, representing between intervention arm differences in risk (ref arm = usual care).

Results. Participants were similar on baseline characteristics and number of phone calls completed in follow-up. Participants in the seated exercise program attended an average of 2.9 more classes (p=.017). Adjusted for classes attended, OTM participants had a significantly reduced risk of hospitalization (22.0 vs 30.4%; adjusted odds ratio (OR)=0.57; p=.021); however, the risk reduction for falling (34.1 vs 39.2%; OR=0.71; p=.213), emergency department-use (24.4 vs 24.8%; OR=0.79; p=.444), and having all three aforementioned outcomes (43.1 vs 52.0%; OR=0.64; p=.129) was not statistically significant.

Conclusions. For community-dwelling older adults, participating in OTM, led to a reduced risk of hospitalization in the 12 months after program completion, compared to a usual-care seated group exercise program.

Clinical Relevance. OTM may play a key role in future wellness prevention strategies to reduce hospitalization; clinicians may consider facilitating the transition to such programs for older patients.

Effects of “On the Move” Exercise Program on Falls and Healthcare Utilization in Older Adults

Peter C. Coyle, PT, DPT, PhD // Subashan Perera, PhD // Steven M. Albert // Janet K. Freburger, PT, PhD // Jessie VanSwearingen, PhD, PT // Jennifer Brach, PT, PhD

HEALTH POLICY

Submissions Open for CSM 2020

Visit www.apta.org/CSM/Submissions to learn more

and submit your abstract for consideration.

23

ABSTRACT

Vol 19 Issue 1 Physical Therapy Journal of Policy, Administration and LeadershipPhysical Therapy Journal of Policy, Administration and Leadership Vol 19 Issue 1

Using Clinical Data to Drive Clinical Practice: Bringing Practice Change to Scale

The following abstract is the winning poster presentation from the Combined Sections Meeting (CSM) 2019 HPA The Catalyst Platform Competition in Washington, D.C. Be sure to attend the HPA The Catalyst poster presentations at CSM 2020 Feb. 12-15, 2020, in Denver, CO.

Patricia L. Scheets, PT, DPT, MHS // Michael C. Billings, PT, DHSc, MS //Patrick Hennessy, PT, MPT

Purpose. We have an ongoing company initiative to restructure post-acute therapy services to transition from a volume-driven to a value-based reimbursement model. Our basic assumption is that different patients need different amounts and types of rehabilitation and that matching these factors outside of a volume-driven reimbursement climate will lead to improved outcomes relative to costs (value) for rehabilitation.

Description. The initial steps of this initiative were a standardization of outcome measurement and established processes for data extraction and reporting. These steps have allowed us to identify characteristics of our usual care environment and study changes associated with the rollout of the care-delivery model. The care delivery model consists of three pillars: intensity, patient self-management, and maintenance and prevention. Concurrently, we completed a cluster analysis of the outcome data from 26,000 patients collected over 20 months. We found 4 clusters of patients with distinct characteristics. Two of the clusters were identified as high value because the patients achieved high outcome levels at low cost. A third cluster was a low value cluster because these individuals made modest gains at higher cost due to long lengths of stay. The final cluster is our primary cluster of interest for future initiatives. These patients made minimal gains stay and were discharged at outcome levels associated with increased risk of adverse events.

Summary of Use. To date, we have implemented 1 intervention, gait speed training, at approximately 180 skilled nursing facilities. After the first quarter of implementation and compared to the same time period the year previously, we saw modest improvement in average discharge gait speed11 (0.05 m/s), 6-minute walk test distance12-13 (6MWT) (6.9 m), and total Short Physical Performance Battery (SPPB) scores (0.3 points). Additionally, we saw modest gains in the change scores of these metrics (0.04 m/s, 7.4 m, 0.31 points respectively). We are in process of implementing patient self-management interventions15-18 across all sites. In a pilot group of 69 patients, we saw consistent gains in physical performance and self-efficacy scores (discharge and change) when compared to our usual care outcomes. Improvements in the change scores for gait speed, 6MWT, and SPPB were 0.09 m/s, 29.1 m, and 1.73 points respectively. We have used the results of the cluster analysis to set company-wide outcome targets consistent with the discharge values of our high value groups. These targets have been shared with the clinicians across the company.

Importance to Members. We have used systematic performance improvement and knowledge translation processes to influence clinical behavior. The use of clinical outcome data has been central to the understanding of the opportunities for improvement, in measuring our usual care and comparison group outcomes during pilot studies, and in engaging our clinicians and patients in a meaningful way.

Effects of “On the Move” Exercise Program on Falls and Healthcare Utilization in Older Adults

Peter C. Coyle, PT, DPT, PhD // Subashan Perera, PhD // Steven M. Albert // Janet K. Freburger, PT, PhD // Jessie VanSwearingen, PhD, PT // Jennifer Brach, PT, PhD

PRACTICEADMINISTRATION

Submissions Open for CSM 2020

Visit www.apta.org/CSM/Submissions to learn more and submit your abstract for consideration.

HPA The Catalyst CSM 2019 Programming Was Transformational

Thank you to the following individuals who presented HPA The Catalyst-supported programming at the Combined Sections Meeting 2019!

Gail Altekruse, PT, MBAJennifer Angeli, PT, DPT, PhDSusan Appling, PT, DPT, PhDJennifer Audette, PT, PhDEmily Becker, PTJim Benedict, PT, PhDDoug Benson, DPTMichael Billings, PT, MS, CEEAAJill Black, PT, DPT, EdDJennifer Brach, PT, PhDAlicia Campbell, SPTCarolina Carmona, PTJillian Carney, PTASusan Chalcraft, PT, MSAliya Chaudry, PT, JDCathy Ciolek, DPTMaurine Coco, PT, MSPTJohn Corcoran, PTMargaret Danilovich, PT, PhDTodd Davenport, PT, DPT, MPH, OCSDonna Diedrich, PT, DPT, GCSLoretta Dillon, PT, DPT, MSBrianna Durand, SPTJamie Dyson, PT, DPTDaniel Dziadura, PTAnna Edwards, PT, DPT, MA, MBA

Aaron Embry, PT, DPT, MSCRPaula Eppenstein, PT, MSJason Falvey, PT, DPT, FCSDerek Fenwick, PT, MBA, FCSMichael FriedmanKara GainerApril Gamble, PT, DPTRick Gawenda, PTKaren Gordes, PT, PhD, DScPTIra Gorman, PT, PhDSarah Greenhagen, DPT, GCSSean Griech, PT, DPT, CSCSShawn GrimesTina Gunaldo, PT, DPT, MHS, PhDJeff Hartman, DPT, MPHFelix Hill, SPTMelissa Hofmann, MSPT, PhDMaggie Horn, DPT, MPH, PhDJeff HouckBrian Hull, PT, DPT, MBAStephen Huntsman, PTAmy Hurst, PhDSusan Jeno, PT, PhDJoshua Johnson, DPTLaura Keyser, DPT, MPHSusan Klappa. PT, PhD

Deborah Kucera, PTSowmya Kumble, PT, MPT, NCSAmy Lafko, PTMichel Landry, BScPT, PhDRobert Latz, PT, DPT, CHCIOAlan Lee, PT, PhD, DPT, CWS, GCSCariAnn Litz, DPTRoberto López-Rosado, DPTDawn Magnusson, PT, PhDRobin Marcus, DPT, PhDSandy McCombe Waller, PT, PhD, NCSAddie Middleton, DPT, PhDDaniel Millar, SPTDebora Miller, PT, MBA, FACHEJulie Miller, PhDDavid Morris, PT, PhD, CEE-AA, FAPTAChristopher NorenTara Pearce, PT, DHSLori Pearlmutter, PT, MPHCelia Pechak, PT, PhDDaniel Pinto, PT, PhDSara Pullen, DPT, MPHCatherine Quatman-Yates, PT, DPT, PhD

Sudha Raman, BScPT, PhDJason Robinson, PT, SCS, PES, CSCSMegan Roos, PT, DPTBeth Sarfaty, PTCatherine Schmidt, PT, DPT, MS, PhDLaura Schmitt, PT, MPT, PhDPaula Shulthiess, PT, DPTMatt Sivret, PTHeather SmithEllen Strunk, PT, MS, GCS, CEEAA, CHCJillian Tanych, DPTAnne Thackeray, DPT, PhDLeonard Van Gelder, PT, DPT, AT, ATC, TPS, CSMT, CSCSKerri Vanderbom, PhDEvelyn Villarreal, SPTVien Vu, PT, DPT, CSCSJaclyn Warshauer, PTNancy White, PT, DPTAmanda Williamson, PT, DPTDaniel Young, PT, DPT, PhDStacey Zeigler, PT, DPT, MS, GCSVanessa Ziccardi, PT, DPTChristin Zwolski, PT, DPT, OCS

february 2019 vol. 19 // no. 1€¦ · abstracts from the award-winning platform and poster...

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