Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Physical therapy [journal]
- Infants Born Preterm Demonstrate Impaired Object Exploration Behaviors Throughout Infancy and Toddlerhood. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 28.
Object exploration behaviors form the foundation for future global development but we know little about how these behaviors are performed by infants born preterm.To longitudinally compare a comprehensive set of object exploration behaviors in preterm and full-term infants from infancy into toddlerhood.We followed 22 full-term and 28 preterm infants as they interacted with objects throughout their first two years.Infants were provided up to 30 seconds to interact with each of seven objects across nine visits. Experimenters coded videos of infants' behaviors. Growth modeling and t tests compared how much infants performed behaviors and how well they matched their behaviors to the properties of objects.(1) Infants born preterm explored objects less in the first six months, (2) Infants born preterm with significant brain injuries had impaired bimanual abilities, (3) Infants born preterm performed less visual-haptic multimodal exploration, (4) Infants born preterm displayed reduced variability of exploratory behavior in a manner that reflected severity of risk, and (5) Infants born preterm were less able to match their behavioral performance to the properties of objects in a manner that reflected severity of risk.There was a limited sample of infants born preterm with significant brain injury.Infants born preterm have impaired abilities to interact with objects even in the first months of life. This likely limits the knowledge they acquire about objects and about how they can act on them, which in turn may impair their early learning abilities. These results highlight the need for assessment and intervention tools specific for object exploration in very young infants.
- Reliability and Validity of Play-based Assessments of Motor and Cognitive Skills for Infants and Young Children: A Systematic Review. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 28.
Play is vital for development. Infants and children learn through play. Traditional standardized developmental tests measure if a child performs individual skills within controlled environments. Play-based assessments can measure skill performance during natural, child-driven play.The purpose of this study was to systematically review reliability, validity, and responsiveness of all play-based assessments which quantify motor and/or cognitive skills in children birth to 36 months of age.Studies were identified from a literature search using PubMed, ERIC, CINAHL, and PsycInfo databases, and the reference lists of included papers.Included studies investigated reliability, validity, or responsiveness of play-based assessments that measured motor and/or cognitive skills for children to 36 months.Two reviewers independently screened 40 studies for eligibility and inclusion. Reviewers independently extracted reliability, validity, and responsiveness data. They examined measurement properties and methodological quality of included studies.Four current play-based assessment tools were identified in 8 included studies. Each measured motor and/or cognitive skills in a different way during play. Inter-rater reliability correlations ranged from 0.86-0.98 for motor development and 0.23-0.90 for cognitive development. Test-retest reliability correlations ranged from 0.88-0.95 for motor and 0.45-0.91 for cognitive. Structural validity correlations ranged from 0.62-0.90 for motor and 0.42-0.93 for cognitive. One study assessed responsiveness to change in motor development.Most studies had small and poorly-described samples. Lack of transparency in data management and statistical analysis was common.Play-based assessments have potential to be reliable and valid tools to assess cognitive and motor skills, but higher quality research is needed. Psychometric properties should be considered for each play-based assessment before it is used in clinical and research practice.
- Minority Applicants to Physical Therapist Education Programs 2010-2012. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 28.
In 2011-12, despite comprising 35% of the US population, minorities comprised 20% of applicants and 15% of enrolled students in accredited physical therapist education programs. Solutions aimed at addressing current disparities in healthcare may include educating physical therapists in environments reflecting the increasing diversity of the US population.The purpose of this study was to describe the underrepresented minority (URM) applicant pool to PTCAS member programs and investigate differences in application patterns between White and URM applicants in 2010-2012, including total number of programs applied, likelihood of applying out of state, and application to programs with minority faculty.National, retrospective descriptive study METHODS: De-identified data consisting of 11690 applicants in 2010-2011 and 13462 in 2011-2012 were obtained including applicant demographics, selected metrics, and admission decisions. Descriptive statistics and ANOVA with multiple comparison procedures (Tukey HSD) were used to investigate differences between White and URM applicant metrics and application patterns.White applicants achieved significantly greater GPA and GRE scores than Hispanic and African American applicants (p<0.05). Although there were no significant differences in the average number of programs applied to between White and URM applicants, Hispanic applicants were significantly more likely to apply to programs within state of residence (p<0.001). URM applicants were significantly more likely to apply to programs with minority faculty (p<.05).This study does not attempt to generalize the results beyond PTCAS institutions.Hispanic applicants demonstrated a significantly increased likelihood of applying within their resident state. URM applicants also demonstrated a significantly greater tendency to apply to PTCAS member institutions with minority faculty.
- Dual Tasking With the Timed "Up & Go" Test Improves Risk-of-Fall Detection in Patients With Parkinson Disease. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 21.
Falls are a common and disabling feature of Parkinson's disease (PD). Early identification of patients at greatest risk is a key goal of physiotherapy assessment. The 'Timed up and Go' test (TUG) is a frequently used mobility assessment tool, which demonstrates moderate sensitivity and specificity in identifying falls risk.To investigate whether adding a dual task (cognitive or manual) to the TUG increases the test's utility to identify risk of falls in persons with PD.A retrospective cohort study of persons with PD (n=36).Participants were compared on the basis of self-reported falls exposure in the previous 6 months (fallers vs. non-fallers). The time taken to complete the TUG, TUG-cognitive and TUG-manual was measured in both groups. Between-group differences were calculated using Mann-Whitney U tests. The discriminative performance of the test was examined at different cut-off points and estimates of sensitivity and specificity were based on receiver operator characteristic plots.Fallers took significantly longer than non-fallers (n=19) to complete the TUG test under all three conditions (TUG p =0.005, TUG-cognitive p =0.001, TUG-manual p =0.005). The TUG-cognitive demonstrated optimal discriminative performance (AUCROC=0.81, 95% CI 0.64-0.92) at a cut-off of 14.7 seconds. The TUG-cognitive is more likely to correctly classify those at low risk (LR+=2.9) (<14.7 seconds) with higher estimates of sensitivity (0.76, 95% CI 0.52-0.90) than specificity (0.73, 95%CI 0.51-0.88) at this threshold (LR-=0.32).Retrospective classification of fallers and non-fallers was used.Addition of a cognitive dual task to the TUG enhances identification of falls risk for patients with PD. The TUG-cognitive test should be considered as a component of a multifaceted falls risk assessment in PD.
- Reproducibility and Validity of the Physical Activity Scale for the Elderly (PASE) Questionnaire in Patients After Total Hip Arthroplasty. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 21.
The assessment of physical activity is of concern in patients after total hip arthroplasty (THA). So far, no questionnaire has however demonstrated adequate reproducibility and validity for assessing physical activity in these patients.To evaluate the reproducibility and validity of the Physical Activity Scale for the Elderly (PASE) questionnaire in patients after THA.Measurement study.Fifty THA patients (25 women) aged on average 68 years were evaluated. Of these, 25 were assessed between 2 and 7 months after surgery (THAearly) and 25 between 7 and 12 months after surgery (THAlate). PASE reproducibility was evaluated by administrating the questionnaire on 2 different occasions. PASE construct validity was assessed by comparing the physical activity level reported by patients to that objectively recorded by a body-mounted accelerometer. Reproducibility was investigated with intraclass correlation coefficients (ICC2,1) for reliability and standard errors of measurement (SEM) for agreement, while validity was investigated with Pearson correlation coefficients (r).ICC2,1 for the PASE total score was .77 (95% CI: .63 to .86); SEM was 23.0% (95% CI: 19.2 to 28.7). Validity correlation for the PASE total score was 0.38 (95% CI: .12 to .60). No significant differences were found between THAearly and THAlate patients for reliability, agreement and validity outcomes.Reproducibility of the PASE questionnaire could have been underestimated since the physical activity of patients was compared between 2 consecutive but different weeks. Reliability and validity analyses were underpowered.Further study with a larger sample size is necessary to obtain precise reliability and validity estimates. Nevertheless, inadequate agreement calls into question the PASE questionnaire's ability to assess the physical activity level of patients after THA surgery.
- Do Maternal Interactive Behaviors Correlate With Developmental Outcomes and Mastery Motivation in Toddlers With and Without Motor Delay? [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 21.
Maternal interactive behaviors theoretically affect developmental outcomes and mastery motivation in young children. However, these associations are inconsistent in the literature.Three purposes were to: (1) examine the differences in maternal behaviors between toddlers with motor delay (MD) and those with typical development (TD); (2) investigate the correlation of maternal behaviors and developmental quotients (DQs) in toddlers with MD and TD; (3) examine the correlation of maternal behaviors and mastery motivation in toddlers with MD and TD.A sex- and mental-age-matched case-control study.Twenty-two mother-child dyads of toddlers with MD (ages 23-47 months) and 22 dyads of sex- and mental-age-matched TD toddlers (ages 15-29 months) were recruited. Maternal scores from the Nursing Child Assessment Teaching Scale, two indicators of motivation (Persistence and Mastery Pleasure) from individualized mastery tasks and the Dimensions of Mastery Questionnaire (DMQ), and DQs from the Comprehensive Developmental Inventory for Infants and Children were assessed.Mothers of the MD group showed significantly lower cognitive growth fostering scores than those of the TD group. Maternal total scores were significantly correlated with whole DQs in both groups. In the MD group, maternal total scores correlated significantly with DMQ mastery pleasure but not with mastery task motivation.The design makes it impossible to know the causal relationships between maternal behaviors and children's DQs and motivation.Mothers of toddlers with MD exhibited less adequate interactive behaviors than those of the TD group. Because higher quality maternal behaviors correlated with higher DQs in the MD group, clinicians should encourage parents to participate in early intervention programs and model quality parenting behavior to enhance parents' and children's outcomes.
- Factors Associated With Physical Therapists' Implementation of Physical Activity Interventions in the Netherlands. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 14.
Physical therapists play an important role in the promotion of physical activity (PA) and the effectiveness of PA interventions. However, little is known about the extent to which they implement PA interventions following the protocol and factors influencing their implementation behaviors.To investigate physical therapists' implementation fidelity regarding PA interventions, including completeness and quality of delivery, and influencing factors, using a Theoretical Domains Framework (TDF)-based questionnaire.The study was based on a cross-sectional design.A total of 268 physical therapists completed the Determinants of Implementation Behavior Questionnaire. Questions on completeness and quality of delivery were based on the components and tasks of PA interventions as described by the Royal Dutch Society for Physical Therapy. Multilevel regression analyses were used to identify factors associated with completeness and quality.Physical therapists reported high implementation fidelity, with higher completeness compared to quality of delivery scores. Physical therapists' knowledge, skills, beliefs about capabilities and consequences, positive emotions, behavioral regulation, and the automaticity of PA intervention delivery, were the most important predictors of implementation fidelity. Together, the TDF domains accounted for 23% (p < .001) of the variance in both total completeness and quality scores.The cross-sectional design precluded the determination of causal relationships. Also, use of self-report measures to assess implementation fidelity could lead to socially desirable responses possibly resulting in more favorable ratings of completeness and quality.This study enhances our understanding of how physical therapists implement PA interventions and which factors influence their behaviors. Knowledge on these factors may help develop strategies to improve physical therapists' implementation behaviors.
- Author response. [Comment, Letter]
- Phys Ther 2014 Jul; 94(7):1054-5.
- Impaired Reactive Stepping Among Patients Ready for Discharge From Inpatient Stroke Rehabilitation. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 7.
Individuals with stroke are at increased risk for falls soon after hospital discharge. The ability to react to a balance perturbation, specifically with a rapid step, is critical to maintain balance and prevent falls. The purpose of the study was to: determine the prevalence of impaired reactive stepping responses in an ambulatory group of patients with stroke who were preparing for discharge from inpatient rehabilitation and the relationship to patient performance on commonly-used clinical measures of balance, mobility and lower limb impairment.A retrospective chart review of patients with stroke who, at time of discharge, had completed a perturbation-evoked reactive stepping assessment.Ninety nine of 139 (71%) patients had impaired stepping reactions characterized by: the need for assistance, an inability to step with either lower limb, or the need for multiple step responses. There was a statistically significant difference in clinical scores between those with and without impaired stepping but groups were characterized by considerable variation in clinical profiles. For example, Berg Balance scores ranged from 25 to 55 versus 20 to 56 and gait speeds ranged from 0.17-1.43 versus 0.26 to 1.55 m/sec for patients who demonstrated a failed step versus a successful step, respectively.Impaired reactive stepping is a prevalent problem for ambulatory patients with stroke preparing for discharge which could possibly increase their risk of falling when faced with the challenges of community ambulation. Specific tests that target the capacity to perform perturbation-evoked stepping reactions may be important to identify those at risk for falls & to direct appropriate intervention strategies.
- Integrating Aerobic Training Within Subacute Stroke Rehabilitation: A Feasibility Study. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 31.
Aerobic activity positively impacts patients recovering from stroke and is part of best practice guidelines, yet this evidence has not translated to routine practice.The objective was to evaluate the feasibility of a model of care that integrated aerobic training in an in-patient rehabilitation setting for patients in the sub-acute stage of stroke recovery. Key elements of the program were personalized training prescription based on submaximal test and supervision within a group setting.Prospective cohort METHODS: Patients completed sub-maximal exercise testing prior to enrolment, which was used by their treating physical therapist for exercise prescription. Feasibility was evaluated using enrolment, class attendance, adherence to prescription, and patient perceptions.Overall, 31 of 78 (40%) patients were referred to and completed the exercise program. Cardiac co-morbidities were the main reason for non- referral to the fitness group. Program attendance was 77%; scheduling conflicts were the primary barrier to participation. The majority of participants (63%) achieved 20 minutes of continuous exercise by the end of the program. No adverse events were reported, all participants felt they benefited from the program, and 80% of participants expressed interest in continuing to exercise regularly after discharge.Cardiac comorbidities prevented enrolment in 27% of individuals and strategies for inclusion in exercise programs in this population should be explored.This individualized exercise program within a group delivery model was feasible, however, ensuring adequate aerobic targets are met was a challenge and future work should focus on how best to include individuals with cardiac comorbidities.