CoHP - SoPT - Faculty Works

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STRENGTHENING INTRAPROFESSIONAL PRACTICE: OUTCOMES FROM STUDENT-LED DPT/PTA WORKSHOPS GROUNDED IN IPEC COMPETENCIES
(2026-04-16) Slike, Michelle; Abbott, Emma; Crone, Aidan; Bernardo, Marlon; Hinckley, Emily; Pomerleau, Jessica; Reynolds, Mitchel
Background & Purpose: Education on the collaborative relationship between Doctor of Physical Therapy (DPT) and physical therapist assistants (PTA) remains limited despite its recognized importance (Sellheim et al., 2020). This gap is particularly important given evidence that PT/PTA collaborative models yield patient outcomes comparable to PT-only care, while facilitating more efficient discharge (Baumann et al., 2023). Prior research indicates that team-based learning enhances student comfort with collaboration and emphasizes the need for improved role clarity and intentional curricular integration (Hawthorne et al., 2018; Hayward et al., 2021). This study evaluated the impact of student-led workshops on PT and PTA students’ understanding of roles, communication, and teamwork, while also exploring strategies for integrating intraprofessional education into entry-level curricula aligned with accreditation standards. Description: DPT students designed and facilitated two workshops for DPT and PTA students. A literature review and a clinician informed needs assessment identified the key themes of collaboration, role clarity, and communication. The Interprofessional Education Collaborative (IPEC) Core Competencies guided the content. Workshops included didactic sessions on roles, ethics, patient simulations, anatomy dissections, and team-building activities. Pre- and post-surveys assessed understanding of roles and collaboration, with satisfaction surveys evaluating perceived value. Results: A total of 160 participants (113 DPT, 47 PTA) engaged in the workshops. Quantitative analysis showed improvements across all measured domains. Median scores rose from 3 pre-workshop to 4 post-workshop for preparedness, role understanding, communication, delegation, and readiness for collaboration. Mann-Whitney U tests confirmed these gains were statistically significant (p < .05). Participants cited simulations as most impactful for understanding roles and communication, and dissections for fostering teamwork. Suggestions included extending activities and adding more complex cases. Conclusion: Findings support structured, student-led intraprofessional education as an effective method to enhance PT/PTA collaboration. Integrating such models into entry-level curricula may improve role clarity, teamwork, and readiness for team-based care.
WALKING THE PLANK IMPROVES GAIT SPEED AND BALANCE CONFIDENCE IN COMMUNITY-DWELLING OLDER ADULTS.
(2026-04-16) Sidaway, Ben
A third of community-dwelling older adults will fall at least once per year with walking being the leading cause of such falls. In such individuals, the greatest postural instability during walking occurs in the mediolateral direction and thus lateral instability is a significant risk factor for falls. The current study uses one-month of beam walking as a means to challenge the dynamic mediolateral stability of older adults in an attempt to improve balance confidence and falls risk. Participants were 24 community dwelling older adults over 70 years of age (Mean = 83.5 yrs.). Baseline assessment included a fear of falling questionnaire, the Activities-specific Balance Confidence (ABC) scale, the Dynamic Gait Index (DGI), and collection of multiple gait parameters during normal and quick walking. Participants were then assessed on their ability to walk along a series of six wooden beams (6 m long, 2 cm thick) of decreasing widths. Following pretest measurements participants practiced walking on the beams for 20 minutes twice a week for 4 weeks. Gait parameters were collected on the final training day, and all pretest measures were repeated one week later. At pretest, the 24 participants reported 38 falls in the previous six months. A six-month follow-up showed 11 falls after training. At pretest, 83% of participants were somewhat afraid of falling, compared with 37% at retention. Analysis of the ABC data revealed a significant improvement in balance confidence from the pretest (M = 61%) to the retention test (M = 90%). The DGI also improved from the pretest to the retention test. Gait analysis revealed that stride length and gait velocity increased significantly following beam training while stride length and stride width variability decreased. Beam training appears to be a simple intervention that can improve dynamic mediolateral stability consequently reducing the falls risk of older adults.
DPT STUDENTS’ PERCEPTION OF CLINICAL READINESS AND CONFIDENCE IN THEIR KNOWLEDGE, SKILLS, AND ATTITUDES (KSAS) BEFORE THEIR FIRST FULL-TIME CLINICAL EXPERIENCE
(2026-04-16) Holmes, Jadyn; Piper, Emily; Richardson, Cierra; Saucier, Caileigh; Warren, Akira; LaPrino, Stephanie
Introduction Clinical experiences are essential in physical therapy education to bridge the gap between didactic learning and clinical practice. Early, contextualized opportunities, such as a student-run Pro Bono clinic, enhance skill development, confidence, and preparedness. Prior research suggests early clinical exposure improves self-perceived readiness for practice (Kalistratova et al., 2024). Additionally, competency frameworks have identified essential knowledge, skills, and professional behaviors required before initial clinical experiences. This study used a survey-based approach to evaluate Doctor of Physical Therapy (DPT) students’ perceived readiness and confidence prior to clinical placement. Methods A clinical readiness checklist adapted from Timmerberg et al. (2019) was organized into 13 domains encompassing knowledge, skills, attitudes, and professional behaviors. Participants rated perceived competence using a four-point Likert scale (Unfamiliar to Proficient). Eligible students completed an anonymous electronic survey via Google Forms after providing informed consent. No identifying information was collected. Results Students reported lower perceived competence in common diagnoses (36%), pathology (50%), infection control (31.8%), and self-introduction (40.9%), despite expected performance of “at least emerging.” In areas such as self-care, measuring muscle length, sensory assessment, legal considerations, and patient–provider relationships, 70–80% met expectations, while approx. 22% did not. For professional skills, 80–90% met expectations, with deficits noted in manual muscle testing and HIPAA (18.18%) and Code of Ethics (14.6%). In contrast, 90–100% met expectations in communication, interventions, patient handling, and documentation, with only 4.5% below expectations in aerobic exercise-related tasks. Conclusion DPT students reported higher confidence in communication and professional behaviors compared to clinical skills and reasoning. These findings suggest a gap between knowledge acquisition and clinical application, highlighting the need for earlier, structured clinical experiences to enhance readiness and self-efficacy.
KNEEHAB MULTIPLE ELECTRICAL STIMULATION AND MUSCLE FATIGUE
(2026-04-16) Bryant, Alexander; Meeker, Victoria; Russell, Lindsey; Scott, Wayne
Excessive muscle fatigue (MF) is a limiting factor when using neuromuscular electrical stimulation to strengthen muscles. Stimulation strategies minimizing MF may result in increased strength gains. The purpose of the study was to compare MF produced in the quadriceps muscle via a multipolar Kneehab electrical stimulation garment (MKESG) versus a monopolar stimulator. We hypothesized that MKESG would produce less MF than the monopolar stimulator. Fifteen participants were tested using a Biodex dynamometer to measure isometric knee extensor torque. Maximum volitional isometric contraction (MVIC) muscle torque of the right leg was measured. MKESG intensity was increased to the maximum tolerated intensity for a 10-second contraction. After 5-minutes rest, a 15-contraction fatigue protocol was conducted using a 10-second on/off ratio. Peak torque of each contraction was recorded. The protocol was then repeated using the left leg and a monopolar Grass Stimulator (MGS). Intensity was set to elicit a similar initial percentage of the MVIC torque as tolerated on the right. Fatigue indexes were calculated for both conditions by dividing final contraction peak torque by initial. Average peak torque was also recorded. Paired t-tests were used for statistical analysis. We did not observe significant differences. The mean fatigue index for the MKESG was 0.44 ± 0.13 as compared to 0.43 ± 0.14 for the MGS (p = 0.34). Average peak torque for the MKESG was 31.17 ± 17.77 Nm versus 27.65 ± 16.05 Nm for the MGS (p = 0.07). Our results suggest that the MKESG stimulator does not reduce electrically elicited MF as compared to the MGS, clinicians wishing to do so should explore alternative strategies.
BLOOD FLOW RESTRICTION TRAINING FOR CHRONIC QUADRICEPS ATROPHY AND WEAKNESS
(2026-04-16) Dick, Braden; Gravit, Tara; Hunter, Hayden; Proulx, Tyler; Scott, Wayne
Blood flow restriction training (BFRT) is an exercise modality that utilizes blood flow occlusion in the affected extremity during low-load training. Partially occluding blood flow leads to a hypoxemic state in the affected limb, resulting in build-up of anabolic metabolites, cellular swelling, and increased recruitment of fast-twitch muscle fibers. BFRT stresses muscles differently from typical high-load training. The purpose of this study was to determine if BFRT can reverse long-standing quadriceps atrophy and weakness in an individual following an ACL reconstruction and meniscus repair. A single subject with residual quadriceps atrophy, weakness, and functional impairment trained with BFRT for 8-weeks. The subject participated in two training sessions per week targeting the affected extremity, consisting of three quadriceps exercises at 80% occlusion following a 30, 15, 15, 15 repetition protocol. Outcome measures included thigh circumference and lower extremity strength, which were tested prior to, every 2 weeks during the intervention, and one-week post-training. Functional outcomes were assessed with video analysis of movement and the Knee Injury and Osteoarthritis Outcome Scale (KOOS) at the start and end of the study. After the 8-week training period, a 1-week F/U was conducted to reassess the subjects' knee extensor strength (MVIC), thigh circumference, and KOOS. Thigh circumference decreased across measurement sites (involved limb: 45 to 43 cm at 5 cm superior to the top of patella and 53.5 to 50.5 cm 15 cm superior to the top of patella). Strength asymmetry declined from 69.8% to 49.8% of the uninvolved limb. KOOS improved from 81.55 to 88.10 with subscale increases in symptoms (57.14 to 67.86), sport/rec (70.00 to 90.00), and QoL (50 to 62.5). This study suggests that despite decreases in quadriceps strength and size, BFRT may improve functional outcomes.
AN EXPLORATION OF POTENTIAL DISPARITIES IN PHYSICAL THERAPISTS’ DECISIONS BASED ON RACE AND ETHNICITY OF PATIENTS
(2026-04-16) Lovely, Ambrose; Osuna, Haesel; Wells, Cassandra; Siegel, Sondra
Background/Purpose: Research shows that health care providers exhibit evidence of implicit bias when treating non-white patients. Most existing evidence is concerned with medicine and nursing, while very few studies have been conducted on physical therapists (PTs). Thus, the purpose of this study was to explore the presence of racial or ethnic bias in PT decisions. Methods: A vignette-based survey was created and distributed via email to licensed PTs within the Husson University Clinical Instructor database. The vignette described a patient with shoulder pathology who was receiving care in an out-patient PT setting. Three versions of this vignette were used which were identical except for the patient’s name and an AI-generated image. The variations were intended to represent three distinct racial or ethnic identities, though these were not explicitly stated. One patient appeared to be white, while the other two appeared to be non-white minorities. Participants responded to questions regarding prognosis, plan of care, treatments, expected outcomes, and recommended referrals. Data were analyzed using Fisher’s Exact Test for frequency comparisons. Results: Thirty-eight out of 331 recipients completed the survey, yielding three groups of respondents based on the case each person received. Participants were primarily from the Northeastern region of the USA, with 92% identifying as white. The analysis revealed no statistically significant differences among the groups in all measures assessed. However, two interesting trends were noted. Minority patients were most associated with expectations of longer duration of care and were the least often referred to an orthopedic specialist after limited progress. Conclusion: In this survey, PTs displayed no disparities based on patient race or ethnicity when recommending treatment for shoulder pathology in an out-patient setting. This differs from a large body of literature showing disparities in other health care disciplines, but is mostly consistent with one other similar survey of PTs.
ENHANCING STUDENT PT/PTA TEAMWORK THROUGH SIMULATION: A CASE STUDY
(2026-04-16) Fishburn, Makayla; McCarty, Olivia; Nicknair, Armanda; Poirier, Bryanna; Porter, Makaelyn; Zeigler, Madison; Bochynski, Jennifer
Purpose: This simulation experience case study is to explore how collaborative learning between physical therapist (PT) and physical therapist assistant (PTA) students enhances clinical preparedness and confidence while understanding individual roles. By engaging in a realistic patient scenario, students learned to develop interprofessional communication skills and a clearer understanding of roles. The simulation aims to better prepare students for real-world clinical settings where effective collaboration is essential for patient care and student confidence. Case Description: PT and PTA students were divided into mixed groups consisting of 1st-year DPT students, 1st- and 2nd- year PTA students, and a 3rd-year DPT student acting as a clinical instructor. Groups received a pre-brief reviewing PT/PTA roles and responsibilities, including case-based application of the APTA’s PTA supervision and direction algorithm. During the one-hour simulation, students developed and implemented a treatment plan for a standardized patient. The standardized patient presented with clinical red flags, prompting PTA students to determine appropriate next steps. A structured debrief followed, focusing on communication, roles, and clinical decision-making. Voluntary pre- and post-simulation surveys were completed. Outcomes: Fifty-four students completed both pre and post surveys (65.5% 1st year DPT students, 16.4% 1st year PTA students, and 18.2% as 2nd year PTA students. Mann-Whitney U tests analysis showed statistically significant improvements in four of the five domains: role understanding (p=.029), communication confidence (p=.024), preparedness for teamwork (p=.034), and recognizing scope boundaries (p=.017). PTA students demonstrated higher scores than DPT students pre- and post-simulation (p<.01). Prior clinical experience in various settings was associated with higher confidence levels. Discussion: While most simulation research emphasizes interprofessional education, limited literature addresses intraprofessional PT/PTA training. Findings suggest simulation enhances student confidence, role clarity, and communication. Simulation appears to be a valuable strategy for fostering confidence and role identification in the clinical setting.
TEACHING INTRAMUSCULAR DRY NEEDLING IN ENTRY-LEVEL DPT EDUCATION: A MIXED METHODS EVALUATION OF STUDENT OUTCOMES AND PERCEPTIONS
(2026-04-16) Archuleta, Prentice; Grant, Zachary; Gumprecht, Andrew; Lombardo, Max; Maxsimic, Katrina; Howland, Chad
Objectives: To evaluate learning outcomes and student beliefs following an introductory intramuscular dry needling (IDN) course within an entry-level Doctor of Physical Therapy (DPT) program. Methods: A mixed methods design assessed learning outcomes via readiness and summative assessments, student beliefs via a post-course survey, and planned qualitative exploration through a focus group interview. Participants were from a single DPT cohort. Institutional Review Board approved the study design (Protocol #25PT03). The study ran from May 2025 to March 2026. Results: Thirteen participants completed the course, learning assessments, and post-course survey. Median scores were 100% (IQR: 100–100) on both readiness and summative assessments across safety, anatomy, technique, and professional domains, with no significant differences between assessments (Z = –1.00 to 0.41, p = .783–1.00; r = –0.11 to 0.28). All participants achieved competency in skills assessments across six separate muscles. Survey results showed high satisfaction across course goals, content appropriateness, instructional balance, pacing, lab practice time, faculty facilitation, peer support, ethical/legal awareness, and overall learning experience (median = 5/5; 92–100% agreement). Confidence in performing IDN and understanding of theory and clinical decision-making was comparatively lower (median = 4/5). Participants reported no adverse effects or adverse events. Qualitative analysis of the post-course survey showed themes specific to experiential learning, instructor feedback, course structure, and clinical reasoning. These results guided question development for the focus group interview (analysis in progress). Discussion/Conclusion: Entry-level DPT students showed strong foundational knowledge prior to in-person training, along with skill acquisition following IDN instruction. Findings support early integration of IDN training within entry-level curricula using small-group, experiential learning models that emphasize immediate feedback. Future curricular refinement should prioritize clinical reasoning and confidence for clinical application. The qualitative analysis from the focus interview aims to describe students’ perspectives about IDN education following their clinical education experiences.
ARE YOU TIRED? TREATING FATIGUE WITH PAIN NEUORSCIENCE
(2026-04-16) Bromley, Kiara; Cote, Lindsay; Hohfelder, Ellie; Myles, Cameron; Williams, Lexi; Steinbarger, Kimberly
Background: Fatigue is a prevalent and debilitating symptom among individuals with chronic disease and is often resistant to conventional management strategies. Emerging evidence suggests that fatigue may share neurophysiological mechanisms with central sensitization and chronic pain. Pain neuroscience education (PNE), which targets central mechanisms through cognitive reframing and symptom reconceptualization, may represent a promising non-pharmacological intervention for centralized fatigue. Purpose: To determine whether an educational intervention grounded in pain neuroscience education and the concept of centralized fatigue can improve symptoms of fatigue and central sensitization in individuals with chronic disease. Methods: This prospective, single-group pre-post study was conducted over eight weeks. Participants completed baseline measures including the Chalder Fatigue Scale (CFS) and the Central Sensitization Inventory (CSI). Following baseline assessment, participants attended a one-hour virtual educational session addressing the neurophysiology of fatigue, central sensitization, and practical management strategies. Follow-up assessments were conducted at four weeks (qualitative check-in) and eight weeks (CFS and CSI re-administration). Repeated measures t-tests were used to compare baseline and eight-week scores. Results: Eight female participants completed the study. At eight weeks, there was a statistically significant reduction in CFS scores (p = 0.007) and CSI scores (p = 0.016). At four weeks, 44% of participants reported decreased fatigue, 33% reported no change, and 22% reported increased fatigue. Post hoc power analysis indicated low statistical power (0.09). Conclusion: Education based on pain neuroscience principles may reduce symptoms of fatigue and central sensitization in individuals with chronic disease. While findings are limited by small sample size and low power, results support further investigation of educational interventions as accessible, non-pharmacological strategies for managing centralized fatigue.
THE IMPACT OF A PHYSICAL THERAPY EDUCATION PROGRAM ON IMPLICIT BIAS AND CULTURAL COMPETENCY
(2025-04-17) Ketch, Abigail; McGovern, Abigail; Pelletier, Sophie; Seitz, Kim; Spencer, Jonathan; Siegel, Sondra
Purpose: Cultural competency is essential for physical therapists in providing equitable care to diverse populations. Extensive research has demonstrated that implicit biases adversely affect healthcare delivery across various disciplines such as nursing and medicine; however, limited attention has been given to understanding the impact of physical therapy education on bias. This study aimed to determine whether the Husson University Doctor of Physical Therapy (HUDPT) program reduces bias and improves cultural humility in its students, and whether the didactic courses or clinical experiences have a greater influence on these changes. Methods: Participants included the classes of 2024-2027 in the HUDPT program. Students completed two assessments at three time points: (1) the Cultural Competence Self-Assessment Checklist (CCSAC) and (2) the Harvard Implicit Association Test (IAT). Data were collected at the following times: 1) during year one of the DPT program (DPT1), before exposure to clinical rotations, 2) during year two of the program (DPT2), before two 12-week clinical rotations, and 3) during year 3 (DPT3), after all clinical rotations. Kruskal-Wallis tests were conducted to analyze differences among time points, followed by Tukey’s post hoc test. Results: A statistically significant difference was found in implicit bias scores between DPT1 and DPT3 (p<.05), with a trend toward a difference between DPT2 and DPT3 (p=.06). However, there were no significant differences among the tests of cultural competence for the three groups. Conclusion: These findings suggest that the combination of didactic education and clinical experiences may contribute to decreases in implicit bias; however, these experiences did not appear to influence students' explicit self-assessment of cultural competence. Further research must be done to assess whether increased exposure to greater diversity in patient populations or coursework would further impact scores.
KNEEHAB FATIGUE STUDY
(2025-04-17) Marvin, Nicholas; Pomerleau, Avery; Triplett, Hunter; Scott, Wayne
Excessive muscle fatigue is a limiting factor when using neuromuscular electrical stimulation (NMES) to strengthen muscles. The purpose of this research was to explore the effects of the multipath Kneehab electrical stimulation garment as compared to a more typical unipath stimulator on fatigue in the quadriceps muscle. It has been claimed that the Kneehab reduces muscle fatigue, perhaps increasing its efficacy as a therapeutic device. This study used 7 participants as their own control. Participants’ strength was tested using a Biodex dynamometer to measure isometric knee extensor torque. The maximum volitional contraction (MVC) muscle torque on the right leg was measured and then the Kneehab was tested on this leg. The Kneehab intensity was increased to the maximum tolerated intensity for a 10 second duration contraction. After a 5 minute rest, a 15 contraction fatigue protocol was conducted. There was a 1:1 ratio of on/off times (10 sec on/10 sec off). A similar protocol was then repeated using the left leg and a unipath Grass Stimulator. The intensity was set to elicit a similar percentage of the MVC torque as was tested with the Kneehab on the right leg. Fatigue indexes were calculated using the peak torque from the first contraction and the peak torque produced by the 15th contraction. The average peak torque of the 15 contractions for each device was also measured. We did not observe any significant differences. There were minimal differences between the Kneehab and Grass stimulators for average peak torque (p = .30) and the fatigue indexes (p = .64). There were no significant findings to suggest the Kneehab produces less muscle fatigue as compared to a traditional unipolar NMES device. However, because we only had 7 participants, we may have been underpowered to detect a difference.
BLOOD FLOW RESTRICTION TRAINING: A CASE STUDY
(2025-04-17) Artkop, Kyle; Goodwin, Payton; Palmer, Emelia; Villanova, Brianna; Scott, Wayne
The following study was conducted to determine the efficacy of blood flow restriction training (BFRT) in improving residual quadriceps weakness as an alternative therapeutic intervention for increasing knee strength and stability. The participant demonstrated persistent quadriceps weakness despite previous physical therapy interventions for a MCL and medial meniscus tear of the knee. Two sessions per week for eight weeks of BFRT were performed on the involved quadriceps, utilizing a tourniquet at 80% occlusion pressure. The participant performed the following unilateral exercises: seated knee extensions, step-downs, and leg presses. The participant completed sets of 30, 15, 15, and 15 repetitions, or went to failure. Thirty-second rest breaks were provided between sets during each exercise with the occlusion maintained. At the completion of each exercise, the pressure was released, and a 2-minute non-occluded rest break was taken. Occlusion was restored for the next exercise. At the end of the 8-week training period, the participant's knee extensor strength was retested with a maximal voluntary contraction (MVC). The findings indicated a 5.6 Nm increase in the MVC of the involved quadriceps, demonstrating an improvement in strength. In addition the participant reported there was decreased joint pain, as well as improved knee stability during activities of daily living. These findings warrant further research into the efficacy of BFRT as an alternative treatment method for patients with persistent quadriceps weakness.
LEARNING WITHOUT BORDERS: EXPERIMENTAL EDUCATION & GLOBAL HEALTH
(2025-04-17) Lewis, Miranda; LaPrino, Stephanie
Background & Purpose: This project explores the reflections of a final year Husson University (HU) doctor of physical therapy (DPT) student following a four-week immersion experience in a variety of settings associated with local nonprofits in Delhi, India. International experiential learning has many benefits regarding healthcare including: expansion of skills, increased knowledge of different healthcare systems, improved critical thinking for treatment approaches, and appreciation for uncommon diagnoses. Experiential learning additionally aids in personal development, including improved social and communication skills, adaptability, self-awareness, and cultural awareness. Methods: HU partnered with Child Family Health International (CFHI) for this learning experience and completed preparatory work prior to arrival including a zoom meeting with CFHI’s local medical director and modules focused on increasing cultural awareness, safety and insight into service-learning. During the four-week immersion in Delhi, the student independently rotated between multiple medical settings. In the variety of settings, the student was able to participate in vocational training, adolescent rehabilitation conversations, ophthalmology observation, HIV/AIDs education and physical therapy interventions for those with neurological conditions. Additionally, the student performed a potential needs assessment of Apollo Hospital and Dr. Shroffs Charity Eye Hospital, creating a list of items and resources needed to improve treatment. Reflection & Limitations: The partnership with CFHI and a variety of nonprofits in Delhi gave this HU DPT student a great insight into the expectations of global learning. The pros and cons discussed in literature are aligned with the experience of the HU DPT student, seen through positive interactions and lasting relationships formed with staff in the PT department. Revealed limitations include language preparation, prior clinical knowledge and differences in healthcare system structure, reducing optimal communication effectiveness. Future student recommendations include more prior clinical experience, an introduction into the local dialect, and potential meetings with CCTH staff prior to arrival to discuss the variety of experiences offered, as well as overall environment and expectations. This project explores the reflections of a final year Husson University (HU) doctor of physical therapy (DPT) student following a four-week immersion experience in a variety of settings associated with local nonprofits in Delhi, India. International experiential learning has many benefits regarding healthcare including: expansion of skills, increased knowledge of different healthcare systems, improved critical thinking for treatment approaches, and appreciation for uncommon diagnoses. Experiential learning additionally aids in personal development, including improved social and communication skills, adaptability, self-awareness, and cultural awareness.
ARE YOU TIRED? AN INTERVENTION FOR CENTRALIZED FATIGUE BASED ON PAIN SCIENCE – A PILOT STUDY
(2025-04-17) Burgio, Chiara; Davis, Michaela; Grinnell, Emily; Perez, Leonardo; Robichaud, Grace; Steinbarger, Kimberly
Introduction: Fatigue is a debilitating condition affecting up to 80% of individuals with inflammatory rheumatic diseases, with severe fatigue impacting up to 42% of this population. Despite its prevalence and significance, fatigue remains under-addressed in clinical practice, especially in patients with centralized fatigue, a condition where sensory input is amplified across multiple systems. Recent evidence suggests that centralized fatigue, like centralized pain, may benefit from interventions grounded in pain science principles. This proposed study aims to evaluate the feasibility of a Pain Neuroscience Education (PNE)-based intervention in managing fatigue. Methods: Five adults were recruited for this pilot study. Adults aged 18 and older, both healthy and those with chronic diseases, were recruited from the local area. Exclusion criteria included children and individuals with sensory deficits in the hands. Participants received baseline assessments using the Chalder Fatigue Scale, Central Sensitization Inventory, and Wind-up Ratio (WUR), a test for centralized sensitivity. They then participated in an educational session focused on understanding fatigue and central sensitization, delivered by investigators blinded to their survey results. Following the session, participants were contacted at 4 weeks for follow-up, and reassessed at 8 weeks using the same measures. Discussion/Conclusion: The proposed study has good feasibility with a few modifications. It was difficult to recruit participants in person and coordinate the three touchpoints on a consistent timeline, therefore the measurement data is incomplete. The authors recommendation is to drop the only in person, non-survey measure, the wind up ratio. Without this measure, the entire study can be completed online, which will make recruitment and scheduling easier. This intervention holds potential for improving non-pharmacological treatment options for fatigue, particularly in individuals with chronic inflammatory conditions, where fatigue often limits daily functioning. The eventual results may offer a novel approach to managing fatigue through education based on pain science principles.
ENHANCING CANCER SURVIVORSHIP EDUCATION: A COLLABORATIVE WORKSHOP APPROACH TO ONCOLOGY REHABILITATION
(2025-04-17) Alley, Mikaela; Boy, Virginia; Cailler, Taylor; Giles, Ben; Marter, Marissa; McCannell, Jessica; Strickler, Julia; Bochynski, Jennifer; Slike, Michelle
Purpose: As the number of individuals diagnosed with cancer continues to rise, the need for physical therapy intervention to support physical and mental well-being is becoming increasingly important. Seven doctor of physical therapy students and two physical therapy educators created two educational sessions on oncology topics for the community in Bangor, ME. Goals were to improve student knowledge in oncology topics and provide education to the community regarding the benefits of oncology rehabilitation to improve quality of life. Description: Students developed learning objectives and presentations utilizing learning theories, including: connectivism, constructivism, and andragogy to design two workshops. These workshops included presentations with an incorporation of active learning activities. Topics were determined based on community needs and included: an introduction to oncology rehabilitation, cancer related fatigue, exercise, cancer related pain, lymphedema, chemotherapy-induced peripheral neuropathy, and mental health. These evidence-based workshops were available in-person and remotely via Zoom. Assessment of the learning experience included a participant pretest and post-test and a satisfaction survey. Outcomes: 16 participants attended with two participants attending both presentations. 87% of the participants improved their score from pretest to post-test. The remaining 13% had the same score. Overall, participants felt each workshop was highly organized and reported satisfaction with the material and its relevance to their everyday lives. Participants were also satisfied with the hands-on learning activities. Importance and Future Considerations: Participation in these workshops brought awareness to cancer survivors and caregivers on the benefits of PT rehabilitation. DPT students benefited from this project by growing their knowledge of oncology rehabilitation and their ability to provide patient education. Based on the research outcomes, cancer survivors may benefit from additional education regarding their condition management. Through hands-on workshops, cancer survivors may be more satisfied and prepared to manage their conditions.
THE EFFECT OF PATIENT EDUCATION ON OUTCOMES IN PATIENTS WITH RHEUMATOID ARTHRITIS: AN UMBRELLA REVIEW
(2024-04-18) Belanger, Jordan; Cushing, Mary; Edberg, Grey; Grafas, Maria; Steinbarger, Kimberly
Background: According to the World Health Organization in 2019, 18 million people worldwide were living with rheumatoid arthritis (RA). Self-management education is intended to allow persons with RA to manage some aspects of their disease independently, such as function, mental health, pain management, and quality of life. The purpose of this umbrella review was to clarify the efficacy of patient education on function, pain, self-efficacy, and quality of life of those with RA. Methods: A review of existing literature was conducted following the JBI Manual and PRISMA guidelines, utilizing the PICO question ‘In adults with RA, does patient education compared to no education affect the outcomes of function, pain, self-efficacy, and quality of life?’. The following databases were searched: ERIC, Medline/PubMED, Cochrane, Ovid, and CINAHL. A total of 220 articles were initially selected. After abstract and full article screening by the 5 researchers, a total of 9 systematic reviews were included. Results: The most consistent evidence in support of patient education was for the outcomes of reducing pain and depression in patients with RA. Self-management techniques demonstrated strong evidence for the improvement of joint pain. Under quality of life, specifically for depression, there was moderate evidence in support of patient education. Conclusion: Although there was evidence suggesting patient education had positive effects on depression and pain, gaps in the literature remained. Limitations to this study included possible missed article extraction due to words/phrases searched, inherent bias in appraisal and article selection, reporting of existing reviews, and nonconformity of outcome measures utilized in the literature. Recommendations included a focus on patient education techniques for those with pain and depression as their dominant symptoms. Further research was suggested regarding the effect of education on quality of life and function, as well as the efficacy of specific modes of education available.
RELIABILITY OF THE BALANCE ERROR SCORING SYSTEM IN STUDENTS: REAL TIME VS. ASYNCHRONOUS ANALYSIS
(2024-04-18) Arnold, Anne E.; Bubar, Britney A.; Caputo, Alyssa A.; Morin, Tyler J.; Siegel, Sondra
Purpose/Hypothesis: Postural control in stance is often assessed following a concussion using the Balance Error Score System (BESS). The BESS includes observation of a person’s balance in 6 different positions. The rater counts how many balance errors occur during each condition. If a patient makes a large number of errors in rapid succession, it may be difficult for the rater to count them accurately, leading to a decrease in reliability. Thus the purpose of this study was to determine whether reliability of the BESS could be improved by using a videorecording of the test, allowing raters to manipulate the recording as needed. Previous studies have shown that the reliability of the BESS is good for novice raters and much higher for experts. Our hypothesis was that viewing a video recording of a participant performing the BESS would improve the reliability for novice raters. Methods: Two pairs of two student researchers were trained by the primary investigator in the scoring of the BESS. Forty-six healthy participants were then recruited by word of mouth and fliers. Each participant performed the BESS while being video recorded and observed by one pair of students. Each student independently scored the participant’s performance. Six weeks later, each student independently scored the video recordings of the same participants. Intraclass Coefficients (ICC) were generated to determine interrater and intrarater reliability. Results: For both pairs, the ICC showed greater agreement for the total BESS scores of the live sessions (.72 and .90) as compared to the recorded sessions (.52 and .74). ICCs for intrarater reliability ranged from .34 to .71. Conclusions: Watching and manipulating a recording of a BESS test does not lead to improved reliability among novice raters. Scoring of the BESS test should be done based on the live session.
CAN BLOOD FLOW RESTRICTION TRAINING REVERSE LONG-STANDING QUADRICEPS WEAKNESS?
(2024-04-18) Gregoire, Jacob; Hammill, Elizabeth; Lemay, Amber; Olsen, Madison; Sargent, Hannah; Scott, Wayne
Background: Blood Flow Restriction Training (BFRT) involves the application of a tourniquet device during resistance exercises, offering a method for muscle strengthening with low-load training, which reduces stress on joints and tissues. BFRT is commonly employed in rehabilitating injuries of the knee including ligament injuries and damage to the menisci. Previous studies suggest that BFRT induces hypertrophy through a combined response to metabolic stress and mechanical tension. Purpose: This study investigated if BFRT could address long-standing quadriceps weakness following ACL, medial meniscus and MCL injury, commonly referred to as the "unhappy triad." Study Design: A case study was conducted on a 24-year-old female soccer player, five years postoperative ACL and meniscus repair, who reported knee pain, weakness, and instability during functional activities and sports. Methods: The participant underwent BFRT sessions twice a week for eight weeks. Exercises were performed with 80% blood flow restriction on the affected limb, interrupting arterial blood flow during 3 exercises with a 2-minute rest break in between exercises during which the cuff was deflated. Exercises included unilateral knee extensions, step-ups, and leg presses, comprising four sets of each exercise with repetitions of 30, 15, 15, and 15, with 30 seconds of rest in between each set. Results: Our study revealed improvements in maximal volitional isometric contraction (MVIC) torque, burst torque, self-reported confidence, and thigh symmetry. MVIC torque of the affected limb increased by 8.5% and burst torque increased by 23% indicating enhanced strength. Conclusion: The case study highlights promising outcomes of BFRT in improving strength in the knee extensor muscles of persons with chronic weakness. Future research should explore qualitative assessments and BMI, skinfold measurements, and functional evaluations to provide a comprehensive understanding of BFRT's efficacy.
A SURVEY STUDY EXPLORING THRUST JOINT MANIPULATION CURRICULUMS WITHIN ENTRY-LEVEL DOCTOR OF PHYSICAL THERAPY PROGRAMS
(2024-04-18) Howland, Chad
Background and Purpose: The Commission of Accreditation in Physical Therapy Education (CAPTE) requires entry-level Doctor of Physical Therapy (DPT) programs to produce students competent in delivering physical therapy interventions, which include thrust joint manipulation (TJM). However, no mandate exists concerning TJM curricular design or what constitutes entry-level competency. This study sought to explore the current state of TJM education and provide an update on curriculum characteristics and standards. Methods and Results: An online-based survey was distributed to accredited entry-level DPT programs between September 2022 to August 2023. Eligible respondents were physical therapist educators serving as the primary instructor in musculoskeletal coursework for the spine or pelvis. The survey collected data on program demographics, instructor demographics, TJM curriculum design, and perceived competency of students specific to TJM of the spine or pelvis. Survey respondents’ data was analyzed using descriptive statistics (n = 78). Survey results showed the highest percentage (78.%) of respondents were board-certified orthopedic specialists (OCS), with less than one-half reporting advanced certifications in spinal manipulative therapy (47.4%). Nearly all respondents (94.8%) viewed TJM as an entry-level skill and considered their students satisfactory or above satisfactory by graduation. Most respondents view TJM of the upper cervical spine as a post entry-level skill (Figure). A disparity between spinal regions taught in TJM curricula was observed, with lumbar TJM representing the highest percentage of responses (98.7%). Conclusion: Compared to a decade ago, a higher percentage of physical therapist educators teaching TJM reported advanced certifications in orthopedics or manual therapy. However, both program and TJM curriculum characteristics appear comparable to previous reports. The results from this study may not be generalizable to all entry-level DPT programs given the low response rate.
IMPROVING QUALITY OF LIFE FOR CANCER SURVIVORS THROUGH THE IMPLEMENTATION OF A WELLNESS WORKSHOP
(2024-04-18) Cummings, Ashley; Gott, Mallory; Hanning, Amelia; Rowe, Madison; Wasson, Courtney; Slike, Michelle
Research suggests that cancer survivors living in rural communities struggle with adequate resources related to survivorship. Proper education and intervention has been shown to improve life post-diagnosis. The purpose of this project was to design and implement an evidence-based, educational workshop to improve the quality of life for cancer survivors in rural areas of Maine. Following a needs assessment completed through a rural health facility and the YMCA, focus was placed on the following educational topics: physical and mental well-being, fatigue, lymphedema management, and chemo-induced peripheral neuropathy. Two workshops, one in-person and one virtual, were completed in an effort to reach residents in rural areas of Maine. Both workshops were two hours long and were designed and taught by entry-level doctor of physical therapy (DPT) students. Content was delivered using a PowerPoint presentation and active learning strategies. A total of 12 participants completed the workshop, 9 in-person and 3 virtual. Assessment of teaching effectiveness was completed utilizing pre- and post-test assessments, satisfaction surveys, and follow-up phone call interviews 6 months following the competition of the workshop. Strengths identified by the participants during the assessment included organization, informative content, and detailed resources that could be used following the workshops. Weaknesses identified included PowerPoint presentation style and the preference of in-person versus virtual learning. Notably, education on oncology rehabilitation, lymphedema, fatigue management, and chemo-induced peripheral neuropathy led to awareness of resources and enhanced self-care abilities. Wellness resources are lacking for cancer survivors in rural locations throughout the United States. This demand can be met through educational workshops similar to this project. Providing cancer survivors with educational information can improve their quality of life, reduce the risk of recurrence of cancer, and improve the effect of chronic conditions often experienced by cancer survivors.

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