Outcomes – A Strong Team Produces Better Results
Estimated Reading Time: 3 minutes
Every morning as I roll over to silence my alarm, I spend a few minutes indulging in my guilty pleasure of devouring the day's news headlines before pulling myself out of bed to take on the day. One particular day, I came across a story published by NPR: "Trying Physical Therapy First for Low Back Pain May Curb Use of Opioids." My interest was immediately piqued – this was much better than the typical political banter or latest celebrity gossip dominating the headlines. Feel free to stop here and read the entire article, but for those who want the short version, it basically highlights that PTs and PTAs can improve outcomes and decrease health care costs for patients with low back pain.
In school, we are told of the positive impact our work can have on changing the future of the medical landscape, and anyone who has had a patient personally thank them for helping to regain their independence has had this point confirmed a hundred times over. However, reading the NPR article makes me somehow feel differently about our impact. It represents public validation. It is national recognition that the careers we are pursuing can do some pretty great things for the individuals we treat and society as a whole.
True, this article only addresses low back pain, but I think it's important to recognize that headlines like these are becoming more and more common. For example, here's another article from US News and World Report titled, "Can Physical Therapy After Breast Cancer Surgery Reduce Risk of Lymphedema?" With increased exposure in the news and mounting expectations to deliver high-quality, research-driven, value-based care, it is important that we meet the standards that are being set for us.
There are many reasons why our patients occasionally don't get better: insurance issues, lack of patient compliance, unrealistic productivity expectations, deficient resources, poor communication within the medical team, etc. However, beyond these reasons research has shown that PTs and PTAs can do some amazing things if our practices are consistent.
It turns out that we can be pretty bad at tracking our outcomes (although we are getting better). Reasons abound as to why this is, but we are coming to a point in health care where hard data rules, and our profession can no longer afford to ignore this trend. Tracking outcomes helps facilitate the implementation of evidence-based care, demonstrates our financial worth, and cultivates patient satisfaction. By applying research-driven interventions directed by clinical practice guidelines, clinical prediction rules, and validated outcome measures, we can produce economically sustainable results, while enhancing the patient's quality of life.
Although PTs establish a patient's plan of care, PTs and PTAs share an obligation of achieving successful outcomes for our patients based on the interventions we provide. This is where a good PT–PTA relationship comes into play and any good relationship begins with respect, communication, and understanding. In turn, we can help facilitate a mutually beneficial relationship that not only creates a collaborative environment for professional growth, but also a space for shared interest in the care of our patients.
For this to occur, we must first remain steadfast in our accountability to each other. By cultivating open collaboration between PTs and PTAs and properly using the ever-growing research and resources we have available, perhaps we can truly fulfill our shared vision of transforming society by optimizing movement to improve the human experience.
We are #BetterTogether.
American Physical Therapy Association. Free APTA course LMS-353 - Leading the Team: A Practical Guide to Working With PTAs. http://learningcenter.apta.org/default.aspx. Accessed September 10, 2018.
WebPT. Physical therapists' guide to outcomes tracking. WebPT website. https://www.webpt.com/outcomes-tracking. Accessed September 10, 2018.
American Physical Therapy Association. Clinical practice guidelines. http://www.apta.org/EvidenceResearch/EBPTools/CPGs/. Accessed September 10, 2018.
American Physical Therapy Association. Outcome measures in patient care. http://www.apta.org/OutcomeMeasures/. Accessed September 10, 2018.
Justin Kirchmer, SPT
PT–PTA Rehab Team: Continuum of Care
Estimated Reading Time: 3 minutes
As a doctor of physical therapy student, I owe much of my success in school to the help of my fellow classmates. We spend more time together in classes, at the gym, and at the library than we do in our own homes. Whether that means delving into confusing class material or being each other's test dummies for Grade V manipulations, we support each other wholeheartedly throughout our program. Each of my classroom colleagues contributes something valuable, unique, and instrumental to the success of our cohort.
Similarly, physical therapists cannot succeed alone in the clinic or hospital. We work with a team of health care providers to bring the best possible care to our patients. During one of my clinical visits, I was shocked to see one PT's schedule, seeing 3 patients in 30 minutes. A packed schedule like this could only be possible with the help of PTAs, "the only individual(s) permitted to assist a PT in selected interventions" according to APTA's policies on supervision of PTAs. After seeing the teamwork between my CI and the PTAs in the clinic and reading resources provided by APTA, I realized that working with PTAs allows us to maximize rehabilitation outcomes of our patients.
The PT is responsible for conducting the examination and evaluating and forming the diagnosis and prognosis of the patient, then determining the interventions needed to help achieve the patient's goals. The intervention phase is where the PTA comes in. Unlike rehab techs and aides, PTAs complete rigorous academic and clinical education that provides them with the knowledge and critical thinking skills to follow a PT's plan of care. They perform interventions, collect data, and modify the interventions to fit the patient's abilities and ensure their safety. PTA Scope of Practice: Skilled PT Service Providers, a Pulse blog article provides more information about the scope of practice or work for PTs and PTAs. In terms of interventions provided by the PTA, be aware that their scope of work is dependent on your state's practice act. Understanding what is within the PTA's scope of work is the first step toward being an efficient team providing optimal rehabilitation outcomes for our patients.
PTs should understand the scope of PTA education as well as their personal skill set. Through an extensive curriculum, PTAs receive training to provide rehabilitation techniques, therapeutic procedures and interventions, documentation, gait analysis, and much more. Additionally, you may decide to use an intervention based on the PTAs specific skill set, depending on their clinical background and whether they have completed continuing education courses or an APTA Advanced Proficiency Pathway (APP) in an area, such as acute care, cardiovascular/pulmonary, geriatrics, home health, oncology, orthopaedics, pediatrics, or wound management. PTs are responsible for supervising the PTA and must ensure all safety parameters are met and understood by each team member working with a patient.
As a PTA works with the patient, they can document the patient's progress as well as any modifications made during the course of care. PTAs have the problem-solving skills to modify the interventions to ensure the patient's safety, comfort, and progress toward the patient's goals. Throughout this process, the PTA and PT remain in constant communication through documentation review as well as continuous discussion with each other and the patient. If at any point the patient's safety is questioned or they are not making progress toward their goals, the PT and PTA should openly discuss these issues and come up with a plan of action together to address them. The PT may choose to reevaluate the patient, redirect the PTA, or provide an intervention themselves.
Understanding these basics in the continuum of care is important to ensure the best outcomes for our patients with our collaborative efforts. If there's anything I've learned in physical therapy school, it's that there are many gray areas in our practice. To address these areas, APTA has provided a more in-depth decision-making algorithm to help guide PTs when supervising PTAs. PTs are not alone in providing optimal care for our patients. We have the help of PTAs to achieve the best quality outcomes for our patients. After all, we're #BetterTogether.
Eleyn Fangonilo, SPT, is a member of the APTA Student Assembly Interprofessional Collaboration Project Committee.
Dear NSC First-Timers
Dear National Student Conclave (NSC) First-Timers,
NSC is packed with fun events and opportunities designed by and for students. Here are some tips, advice, and recommendations for first time conference-goers to make the most of your experience!
Visit the APTA Student Neighborhood
Located in the NSC Exhibit Hall, the APTA Student Neighborhood is a great place to network, grab some freebies, and learn about APTA involvement opportunities. You can even meet the current APTA Student Assembly Board of Directors, and the candidates for next year's board.
The Conference App is Your Lifeline
The NSC app is a key to navigating conference! It contains session information, conference schedule and location information, a badge game, APTA Student Assembly Board of Directors candidate information, and ways to connect with fellow attendees. APTA Student Assembly Board of Directors voting will be conducted through the NSC app too! Download the conference app before you arrive in Providence.
Voting For Your Future Leaders
NSC is where the APTA Student Assembly Board of Directors elections take place. These students will represent all PT and PTA students for the 2018-2019 calendar year, so this election is very important! Take the chance to network with the candidates throughout the conference. All voting is done through the NSC app.
Network. Meet-up. Socialize. #PTFam.
A huge part of NSC is getting the chance to meet PT and PTA students from across the country who share your love for our profession. Don't miss out on events like the Marquette Challenge PT Pub Night or the PT-PAC party! They are worth losing sleep. Going alone, or want to be paired with a conference buddy in advance? Sign-up for Conference Connections.
Be Prepared for Lots of Goodies
This conference is full of giveaways! You'll walk through the Exhibit Hall with your arms full of cool goodies so pack for the weekend with that in mind.
Snacks. Comfortable Shoes. Water Bottle. Pens. Resume.
These are all optional items to bring with you to NSC, but as an experienced conference goer, these are some great things to have on hand.
Ignite Your Passion
NSC is the only APTA conference designed by and for students, and all of the speakers and sessions reflect that. NSC features a session entitled the Ignite Talks, where multiple presenters deliver engaging talks about a topic relevant to students. Also, don't miss the NSC keynote speaker, Dave Davlin, and the annual Town Hall with APTA President Sharon Dunn. Both sessions are guaranteed to inspire you and fuel your passion for our profession.
Expand Your Knowledge
Encourage yourself to attend education sessions on topics that are new to you. Also, take advantage of our residency and fellowship reception to learn about all the new and exciting options available to you!
Sigh. Relax, and Have Fun.
Last, but not least, have so much fun! Enjoy your days away from the classroom and studying, you've earned it!
From this passionate PT student to all of you, I want to express my excitement to meet all of you and welcome you to our #PTFam.
Haven't registered? There's still time! Trust us, you won't want to miss NSC 2018! Follow NSC on Facebook, Twitter, and Instagram.
Maria Hierholzer, SPT, NSC Project Committee Chair. Connect with Maria on Twitter at @MHierholzer.
My PT Elevator Pitch
Estimated Reading Time: 4 minutes
My uncle's brother has long-standing cardiovascular issues and wants to start exercising. Admittedly, he was afraid and didn't know where to start.
"Do you have any ideas for where he should go or who he can talk to?"
A good friend joked about "leaking" when she laughed too hard after her first pregnancy.
"I was so focused on being pregnant and getting her out! I never really thought about what the heck would happen to my body afterward!"
My dad had persistent neck and shoulder pain, despite trying to do the strengthening exercises he was given for his rotator cuff.
"I've been doing the exercises my PT gave me last year, but I haven't really been getting better. Sometimes, the pain has started going past my shoulder down into my arm."
The older man I sat across from at the public library was worried about his wife's health and frailty.
"I don't know what we'll do if she has a bad fall."
Any PT or PTA student would respond to all of these scenarios the same way I did: "Have you considered physical therapy?"
By the time we've finished our first semester, talking to anyone and everyone about what physical therapy in particular and movement in general can do for them becomes second nature. How many conversations like that have you had in the past week?
You've probably seen #ChoosePT tacked onto a tweet, or a picture with the bright orange logo and tagline shared on Facebook.
Originally unveiled in 2016, APTA's #ChoosePT campaign raises awareness about the risk of opioids for long-term pain management and physical therapy as a safe and effective alternative, as was recommended by the Centers for Disease Control and Prevention.
#ChoosePT, with its core message of PT as the first option in pain management, is essentially the question I asked all of those people in each one of those very different scenarios mentioned above.
Labeling what I did in asking those individuals if they'd considered physical therapy as advocacy might make those conversations sound more formal and aloof than they were, but the heart of advocacy is awareness, all while actively sharing and supporting something you're passionate about.
We live advocacy—in personal conversations and with our patients and clients, and even when someone asks how school is going and we totally light up!
Consciously engaging in spreading awareness about physical therapy is why I carry my #ChoosePT mug and wear my #ChoosePT T-shirt to the park with my dog.
I also decided to use the PTAction app every day that I wear my #ChoosePT shirt because some of the people who most need to hear about physical therapy are federal and state policy makers. How will they understand what our profession can do for those with chronic pain, both before and after they get a script for opioids, if we don't tell them?
In my experience, advocacy requires both setting up the opportunity and preparing to take full advantage of opportunities that materialize. I need to be ready to talk about what #ChoosePT means when I wear my hunter orange shirt and ready to explain how physical therapy can help when I ask, "Have you thought about seeing a physical therapist for that?"
In the business world, the quick and impactful sales pitch you give on the spot for your proposal or passion is your "elevator pitch." I'm always ready to talk about how incredible our profession is, to share my elevator pitch whenever I have the chance to advocate for physical therapy.
"I chose to go into physical therapy because I want to be a part of a patient-first, wellness-first, movement-first profession in a health care world that focuses on "sick-care" and prescriptions too often. Physical therapy isn't just for athletes or recovery after surgery, it's for women before and after giving birth, for weekend warriors, for industrial athletes, for aging well and staying strong, for recovering from heart and lung conditions safely, and for optimizing the way you move now before an injury happens. PTs are highly qualified—we finish physical therapy school with a doctorate—and we have the time to spend to really get to know each patient. In many states, you can even call a physical therapy clinic and schedule an appointment directly, without getting a referral from your primary care provider first! I'm really looking forward to working on a team with my patients to help them take the lead in their health and get back to what they love doing."
Now it's your turn! What's your elevator pitch for physical therapy?
Join us in celebrating National Physical Therapy Month this October! You can learn about #ChoosePT and find ways to support APTA's efforts locally by visiting the online campaign toolkit.
Kate Zenker, SPT, is a current student at Concordia University St Paul. You can connect with Kate on Twitter at @ZisforKate.
Setting The Foundation
Estimated Reading Time: 3 minutes
There's nothing quite like an exam in the morning to give you a swift kick to the ego and start your day.
About 6 weeks ago, the shoulder (including the glenohumeral, scapulothoracic, and scapulohumeral joints) was an enigma. It's my kryptonite joint. But I put my work in and yesterday I thought I had it. Conquered and ready to go for the upper extremity exam. Right now, I'm not so sure that I should have been that confident.
For about 20% of the exam I was convinced there was no actual best or most correct answer. For about 10% of the exam I was convinced that not even one of the answers was correct. I'm going to keep thinking that until reality proves otherwise, so I can maintain my sanity and drag myself through the next exam in 2 days.
Physical therapy school is indescribably worth it, but when it comes down to individual moments it's also pointedly challenging. I continuously say that it's the hardest and easiest thing that I've ever done. Hardest in the sense of the gravity of my poverty, my meek exercise, my continuously declining sleep health, the workload, and my attempts to remain both sane and human during this time. But the ease outweighs all of this. It's an ease that comes with living out your personal legend and progressing toward the dream you were put on this earth to realize.
No matter how long the days, months, and years feel—and trust me they feel long—there's still nowhere else I would rather be. Everywhere else isn't necessarily relaxing, anyway. And I definitely wouldn't prefer an extra year of school to a summer semester or two, even though they aren't my favorite.
For so long, the pattern has been to gain the information to pass the test and then habitually disregard it. I relearn statistics every time I encounter them though they've been sprinkled throughout my education since the eighth grade. This pattern birthed the tendency to do the same now in my doctor of physical therapy program. To do the opposite, to really digest and understand what I'm learning, requires intentionality and focus. Without motivation or a purpose, it's even harder. With that said, if I can manage to maintain a very real patient-centered perspective, I know I'll find success.
That's just one reason why I'm particularly excited for my first clinical rotation. There's nothing that can replace the experience and applying the information I've been manically acquiring for the past year in real situations; simulations can only do so much.
Nothing in the didactic environment can replicate the satisfaction of resolving a major limitation in someone's life or the frustration of not knowing how to. For me, and I presume many others, that's where the intrinsic motivation is residing.
At the end of the day, all the work put into this grind isn't in vain and will strategically position me to provide some real healing for some real people. I have the choice to see these 3 years as the worst of my life or the foundation to the rest of it.
I choose the latter.
It was only a discouraging exam; it is what it is. Even if they were the hardest and most complicated questions that could be asked about physical therapy and the upper extremity, there may be some patients who really need me to fight this battle now to help them win their war later.
Onward and upward to the next exams! But first I'll close my eyes and rest for a while.
Nicole Seward, SPT, is a current student at Clarkson University.
A Hidden Gem for Students and Clinicians
Estimated Reading Time: 2 minutes
In a few months I will receive my doctor of physical therapy degree from the University of South Carolina, sit for the NPTE, and begin my practice as a physical therapist specializing in geriatrics.
It's been a long road to get here, one that I undertook a little later in life than most of my classmates, but I'm excited about what the future has in store.
And honestly, I'm also a bit anxious.
During school and clinical education experiences, we typically have professors, classmates, and clinical instructors to turn to with questions about outcome measures, treatment options, or research evidence. Once we graduate and begin our careers as #FreshPTs the questions will continue, and while we won't necessarily be left to fend for ourselves, we will be expected to be more independent as we seek out those answers.
The importance of a well-stocked clinical toolbox can't be overstated, and one of the tools that you have access to as a member of APTA is PTNow.
Designed by physical therapists for physical therapists, PTNow provides APTA members-only access to the best resources for evidence-based patient care.
Among the information available on PTNow, you'll find:
- Clinical summaries of patient diagnoses
- Clinical practice guidelines
- Tests and measures
- Full-text article searches from a variety of databases
- Cochrane systematic reviews
- Rehabilitation Reference Center
All of these resources are there to help you—as both a student and a clinician—to provide the best patient care possible.
At National Student Conclave (NSC) 2018 in Providence, Rhode Island, I'll introduce you to the resources available on PTNow and show you how to get the most out of the site.
Whether you're a student of physical therapy, and whether you're in your first year or, like me, about to embark on your career, you'll walk away with the knowledge that you need to efficiently find the answers you seek for school assignments, in-services, research projects, and your future clinical practice.
There are lots of exciting presentations on tap at this year's NSC, and I hope you'll take some time to let me show you how PTNow can serve as an important tool in your clinical toolbox.
Bring your laptop, tablet, or phone, and we'll explore what PTNow has to offer together.
Join us October 11-13, 2018 in Providence, RI, for NSC! Register here.
Robyn Culbertson, SPT, is a student at the University of South Carolina and is the current Student Assembly liaison for PTNow. She has been a poster presenter at national, state, and university conferences, and she is the only student physical therapist to present an educational session at the 2018 National Student Conclave in Providence, Rhode Island.
To All Students: Remember, You've Got This
Estimated Reading Time: 2 minutes
The first few weeks into physical therapy school can feel overwhelming. At least it did for me.
From orientation to your first day of class to your second week of class the excitement, while still there, begins to transition into a firm reality – you are now in physical therapy school.
Before this gets too deep into the anxiety, nerves, and the preciousness of time, take it from me: You need to consider that you got past the hard part, getting into the program. Not only that, but you're learning and training to be part of a great profession. Take a minute and remember that.
When you enter your program you quickly become part of a family—#PTfam. You will spend countless hours with your cohort, and for better or worse, this is your new physical therapy family. Just like any other family they will be there through this journey. Lean on them, talk with them, and find fun outlets to relieve stress with them. They will be the ones who will "get it," whatever that "it" may be.
In the first few weeks of your program, there will be quite a few social events with your school and your classmates, so despite the daunting amount of schoolwork, go to those events! This will help you meet your classmates and faculty in a different, more casual setting. This will only help in the long run, you'll put yourself in a great position to form study groups and friendships from the start.
Physical therapy school is by far much more difficult than undergraduate school. From the start, time will become a precious commodity, know that and prepare for it! Becoming organized and scheduling time for healthy activities and quality time with friends and family is really important. My best advice is to block off time on your calendar. Make hard and fast rules about the time designated for school and studying and the time for everything else. Remember though, you are in school studying to become part of the physical therapy profession. This is all really overwhelming now, but remember it's short-term, and again, use your classmates and faculty whether it's for help with school or just to talk it all out.
Even though the anxiety of classes might be piling on and the nerves are still there, you're in the program. Now is the time to buckle up and settle in, because you're now a part of an amazing profession.
Wishing all of my fellow physical therapy students the best of luck and, remember, you've got this!
My cohort at the Mayo Clinic School of Health Sciences
Jason Caselli, SPT, is a student at the Mayo Clinic School of Health Sciences doctor of physical therapy program. You can connect with Jason on Facebook and Twitter.