• News New Blog Banner

  • Study: Ignoring Inappropriate Patient Sexual Behavior Doesn’t Work, but Other Strategies Might

    Inappropriate patient sexual behavior (IPSB) is a problem in health care, but researchers have pinpointed some concrete strategies for responding to these incidents, according to a study in PTJ e-published ahead of print. While several of these strategies can be used by the clinician during treatment, authors say less-than-stellar incident reporting outcomes and lack of administrative support “demonstrate a clear opportunity for the profession to improve.”

    The release of this study happens to coincide with action last week by APTA’s House of Delegates to strengthen the association’s position on sexual harassment in all forms, including encouraging incidents of harassment to be reported, with permission of the affected individual, to ensure that others are not similarly harmed.

    Funded by the APTA Section on Women’s Health, the study follows up a 2017 survey of PTs, PTAs, and students that found 84% experienced IPSB—47% in the previous year. In the prior study, authors defined IPSB as a range of behaviors, "from leering and sexual remarks to deliberate touch, indecent exposure, and sexual assault." Physical therapy clinicians were more likely to experience IPSB if they were female, treating mostly male patients, or newer to the profession.

    Researchers surveyed 1,027 members of APTA specialty sections and students in PT and PTA education programs to learn how individuals who experienced IPSB responded to it, and if those responses were effective at mitigating the problem.

    Similar to the previous survey, 38% had experienced IPSB. The participants described a variety of responses, from simply ignoring the patient’s behavior to documenting and reporting it to management. Respondents who are younger (under age 40) and less experienced (students or clinicians with less than 10 years of experience) were more likely to ignore IPSB. The less experienced group also were more likely to respond by joking with patients. Respondents younger than 40 were more likely to ignore IPBS, while students and newer Not surprisingly, ignoring inappropriate sexual behavior—a strategy used by more than 70% of respondents—was not found to be a successful response.

    Respondents also identified strategies that, according to them, significantly improved the situation more than half the time. They include:

    • Distraction
    • Choosing a more public place for treatment or a different treatment method
    • Direct confrontation
    • Establishing a behavioral contract with the patient
    • Transferring care to a different clinician
    • Using a chaperone

    Authors suggest that clinicians be educated on “assertive communication and redirection strategies” but add that the changes shouldn't stop there.

    There is a “need for clear workplace policies coupled with training for managers and supervisors to support clinicians in resolving IPSB,” authors write. They encourage practices to establish policies on using behavioral contracts and warning letters, chaperones, and transfer of care in response to IPSB.

    (Editor's Note: Articles e-published ahead of print are not the final version. The final version of this article will be published in the September issue of PTJ.)

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    NEXT 2018: Maley Lecture: Health Care Must Adopt a Biopsychosocial Model

    The health care system needs to evolve from a medical to a biopsychosocial model, asserted Robert Palisano, PT, ScD, FAPTA, in the 23rd Maley Lecture, delivered during NEXT 2018. "Healthy living is a societal and systems issue. The focus of the traditional medical model of health care is on the individual and acute conditions." The title of his lecture was "Lifecourse Health Development of Individuals With Chronic Health Conditions: Visualizing a Preferred Future."

    Palisano is associate dean for research at the College of Nursing & Health Professions at Drexel University.

    Lifecourse health development, a biopsychosocial model, previously had been applied to children and youth with cerebral palsy. Palisano extended the concept of lifecourse health development to adults with acquired chronic conditions such as spinal cord injury, traumatic brain injury, stroke, multiple sclerosis, Parkinson disease, and arthritis.

    He noted that APTA's Vision Statement for the Physical Therapy Profession—transforming society by optimizing movement to improve the human experience—served as the springboard for his presentation. Palisano defined "lifecourse" as a progression of socially defined events and roles in which a person engages. Health development, he said, occurs through person-to-environment and environment-to-person transactions that change over time. His preferred future, Palisano said, will be characterized by a person's physical, mental, and emotional well-being; participation in desired social roles throughout life; and achievement of personal goals.

    Using 2 case studies—a boy born with cerebral palsy and a woman who contracted polio at 16 months old—Palisano traced their successful transition from childhood to adulthood and identified experiences that contributed to their lifecourse.

    He said that the transition to adulthood for youth with disabilities has been described as "falling off a cliff" due to lack of preparation, limited support, lack of skills needed for adult roles, and disjointed adult services. He noted that a successful transition requires that timing "real-life" experiences and interventions coincide with the person's environment and readiness for change. "Unfortunately, implementation of comprehensive and coordinated health transition services and supports has not been widely achieved, and finding adult health care providers is often difficult," Palisano said.

    He noted that some laws, such as the Americans with Disabilities Act (ADA), can be of assistance. For example, the ADA defines "disabled but able to work" as an individual with a physical or mental impairment who is able to perform essential functions of a job with or without reasonable accommodations. Employers have a legal obligation to make reasonable worksite and workplace accommodations that are not an undue hardship. However, Palisano cited research that, during the hiring process, employers often have little guidance and are unaware of or do not comply with accommodations required by ADA and other laws.

    Further, he said, "Person-workplace transactions often are not timed or adapted to build capacity." Although assistive technologies "offer promise for improving work participation," access to appropriate assistive technologies and qualified providers and teams are "frequently limited."

    Addressing community living, Palisano said that key considerations are availability, accessibility, adaptability, and affordability. "Research indicates that young adults in supported living experience more variety in community activities and do preferred activities more frequently than do young adults living in group homes."

    Palisano summarized his theme: "The value proposition of lifecourse health development is healthy living. Healthy living involves managing, adjusting, and adapting to changes in health capacities and environments."

    To achieve the vision of a preferred future, Palisano said, "A system similar to the pediatric health system is recommended, whereby the health of adults with chronic conditions would be monitored by interprofessional teams, and a care coordinator would be available to coordinate services."

    He also called for physical therapy to occur in real life settings, also referred to as "natural environments. Research suggests that rehabilitation services in clinical settings do not optimize participation outcomes….Generalization of learning requires practice in different contexts, including open environments that are not predictable."

    Palisano concluded, "A preferred future that embodies lifecourse health development is ambitious, but not beyond the reach of a profession whose vision is to transform society and improve the human experience."

     

     

    2018 NEXT: Physical Therapy Can Play a Part in Addiction Treatment

    The power of physical therapy to help prevent people from starting opioid use has been well-documented, but work now being done by physical therapists (PTs) and physical therapist assistants (PTAs) is showing that the profession also has an important role to play in the lives of those recovering from addiction. And that role has everything to do with applying the knowledge and skills PTs and PTAs already possess.

    In their session "Beyond #ChoosePT: Physical Therapy and the Opioid Crisis," delivered at APTA's 2018 NEXT Conference and Exposition, presenters Mark Bishop, PT, PhD;Eric Chaconas, PT, PhD; and Ahmed Rashwan, PT, DPT, made an engaging, sometimes moving, case for why physical therapy shouldn't be thought of simply as a path for avoiding opioid addiction, but as an approach that can also help addicts achieve and maintain sobriety.

    Chaconas, an associate professor at the University of St Augustine, led the discussion framing addiction as a "cunning, baffling, powerful" disease that doesn't discriminate and should not be associated with a certain class of individuals. The addict's world is, in a way, frighteningly similar to the world of the non-addicted, he said, insofar as the addict is driven to act by cravings that are beyond her or his control. "It's no different from the craving you and I have to drink when we're thirsty or eat when we're hungry."

    Efforts, such as APTA's #ChoosePT opioid awareness campaign, are crucial in helping to stop opioid dependence before it begins, Chaconas said, but there's much more work to be done for the millions whose lives have already been devastated by addiction. Once good place for PTs and PTAs to start: by working with addiction treatment programs.

    Bishop focused his portion of the presentation on the clinical "why" of the matter—specifically, why physical therapy is a profession uniquely suited to join the addiction treatment team. As Bishop explained, it's all about the brain and the ways in which addiction resembles many of the same brain processes as those associated with the experience of chronic pain.

    "If you're comfortable working with someone who's in chronic pain you have the skill set to work with someone struggling with addiction," Bishop said. "If you accept that chronic pain is a neurocognitive disorder, then be prepared to accept that addiction is, too."

    Bishop led the audience through a series of slides that not only explained the neural pathways taken by pain and the cravings experienced by an addict, but highlighted the ways in which dopamine response levels to drugs—which can sometimes be 500 times more powerful than the pleasure responses delivered by food or sex—can fuel addiction. The University of Florida professor also explained the chemical changes that take place when an individual experiences ongoing high stress levels, whether because of chronic pain or via the addiction cycle.

    So how is it that physical therapy can make a difference? Bishop said the PT's ability to help reduce stress and pain are key, but perhaps just as important is the PT's own belief in the power of her or his treatments, and the ability to engage in effective motivational interviewing that helps the patient develop an expectation of improvement.

    According to Bishop, studies have shown that patient faith in any treatment accounts for as much as 30% of the overall improvement experienced. In many ways, he said, the overall change patients experience "depends on what the patient thinks when they come in on day one." If the PT treating the patient with chronic pain can recognize and help to recalibrate those attitudes, improvement becomes that much more possible. "The good news is that those intervention strategies are the same for someone recovering from addiction," Bishop added.

    Rashwan was all about the "how" of the issue. As chief operations officer for Advanced Therapy and Wellness, Rashwan oversees a business that places PTs in addiction treatment centers as integral elements in the treatment process.

    Rashwan developed his business model partly after experiencing frustration with what he called the "hamster wheel" of outpatient physical therapy, and partly by accident. As he explained, one day at his clinic, he received a call from a treatment facility looking for PT services for a few of their patients. Rashwan was happy to take on the patients, but wondered how the facility had decided to call him. The facility staff explained that 2 other clinics had denied providing services after learning the patients were in active treatment for substance use disorder. That's all it took for Rashwan to begin thinking about how to make a difference.

    According to Rashwan, PTs in his company begin working with patients as soon as they've been medically stabilized and are placed in a residential or inpatient treatment setting. Treatments are designed to address any pain-related issues the patient might have, and puts a heavy emphasis on strength training. No modalities are used, and gear is limited to portable strength training equipment, foam rollers, and yoga mats. Keeping things simple and small helps the patient understand that she or he can easily continue the exercises at home, Rashwan explained.

    Rashwan echoed Bishop's emphasis on the importance of establishing a strong therapeutic alliance with each patient. Even among the most recalcitrant of patients, hearing a PT say "I want to know who you are, I want to know what makes you tick" can be a significant experience for someone whose addiction has led to estrangement from loved ones and societal rejection, Rashwan said.

    How to answer the question of whether physical therapy works in the addiction setting depends on who's asking, but the short answer in any case is "yes." Rashwan explained that as PTs and PTAs well know, physical therapy reduces pain and stress, and enhances a sense of wel-lbeing. But the program is also a win for the treatment facilities, which have decreased rates of patient actions "against medical advice" by 22%, increased length-of-stay rates by 15%, and seen improvements in relapse rates and in patient involvement in counseling sessions. And, Rashwan added, there's a business angle that shouldn't be ignored: facilities with a physical therapy program can advertise a more "holistic" approach to treatment, which can increase the patient census.

    Rashwan urged the audience to consider the power of physical therapy in addiction treatment.

    "We're helping people recover," Rashwan said. "We're working with the entire person, not just a diagnosis, and we're planting seeds in our patients. If we can save one life, we've done something important."

    2018 NEXT: PTs Offer Guidance on Developing Leadership Abilities

    A panel of 5 physical therapists (PTs) in various stages of their careers offered NEXT 2018 attendees their advice on how to become leaders and succeed professionally. The PTs were Carrie Cunningham, PT; Michael Gans, PT, DPT; Matthew DeBole, PT, DPT; Stephanie Weyrauch, PT, DPT, MSci; and Elizabeth Nixon, PT, DPT.

    Despite their varying levels of experience and their supporting anecdotes, their advice to those in attendance was similar.

    One agreed-upon observation is that leadership success is usually preceded by failures or setbacks. Cunningham, a board-certified clinical specialist in orthopaedic physical therapy who described herself as a mid-career PT, said, "Falling down is a part of life. I've learned from failures. Don't let fear stop you from the things you need to do to be a leader."

    Nixon, who graduated in 2016, admitted. "I had a lot of failures before I succeeded. For example, I interviewed at the University of North Carolina 3 times before I got in. I applied to get scholarships to attend professional meetings. But I kept losing out, so I paid to attend. I kept applying for scholarships, and I eventually got a few. If I'd given up the first time I'd gotten rejected, I wouldn't be standing here today."

    Many panelists cited positive experiences attending APTA programs, particularly as students. Matthew DeBole recalled, "I attended CSM in Chicago along with 3 other classmates. We were overwhelmed and in awe. There was a major program scheduled that everyone else went to. But I went to another session on leadership. I was super-curious and intrigued. By the time I got back home, I wanted all my classmates to attend the next meeting and even formed a Facebook group so we could attend CSM in San Diego the next year. I was motivated to run for a position on the Student Assembly Board of Directors and won. I was welcomed and helped. Others were open and very willing to help."

    Weyrauch said, "I attended NEXT in Charlotte. At a luncheon, I was seated next to some icons of the profession. And they talked to me—and all of us [with respect]."

    Many agreed on another aspect of academics: Getting the best grades isn't necessary to succeed as a PT or as a leader.

    For instance, Gans—now president of the Connecticut Chapter—admitted, "I wasn't the greatest student. My goal on graduation was to pass the Boards. Then I read Anthony DeLitto's McMillan lecture in PTJ. That alone got me to attend NEXT in 2010, where I heard Andrew Guccione's McMillan Lecture. That convinced me I needed to do more." Gans is a board-certified clinical specialist in orthopaedic physical therapy.

    Weyrauch advised the students in the audience: "Academics is important in physical therapist school, but you're going to have the biggest impact by doing some of those extra things you'll have the opportunity to do."

    Weyrauch presented 6 additional pieces of advice:

    • Be fearless and say "yes."
    • Understand your strengths and weaknesses.
    • Be open to and learn how to give feedback.
    • Network, network, network.
    • Develop expertise and competency
    • Be genuinely accountable and a good listener.

    The others on the panel agreed. Regarding feedback, Cunningham said, "Feedback is a great opportunity for growth."

    On networking, DeBole said: Try to connect with the right people and figure out the best way to go. Continue to connect with the people around you."

    The panel also had some advice for more experienced PTs. Gans said, "It only takes 1 person telling you to get involved. All it took was a single person to fuel my fire."

    Cunningham observed, "There are lots of opportunities in APTA. But you're all leaders in your day-to-day activities, in your own settings, and with your patients. Ask yourself: ‘How can I be better in the clinic every day?'"