What's on the Physical Therapy Research Horizon? A Closer Look at 4 Emerging Foundation-Funded Investigators
The Foundation for Physical Therapy Research, now celebrating its 40th anniversary, is one of the profession's leading supporters of key investigations into physical therapy: how and why it works, how policy and practice changes might support its wider use, and how patient outcomes can continue to improve.
One of the most important ways the Foundation fosters research is by helping student and newly emerging researchers pursue their interests. The Foundation's Promotion of Doctoral Studies (PODS) and New Investigator Fellowship Training Initiative (NIFTI) scholarships do just that—this year, by way of $310,000 in Fellowship and Postprofessional Doctoral Scholarships. APTA is the Foundation's Pinnacle Partner, whose contributions help to support PODS and NIFTI programs, among other Foundation initiatives.
In this #PTTransforms post, we take a closer look at 3 postdoctoral students and the emerging investigator who received awards made possible through APTA's contributions to PODS and NIFTI—specifically, we wanted to find out more about their research, their views on the future of the profession, and what attracted them to physical therapy research.
Brian J. Loyd, PT, DPT, PhD
Recipient of the 2019 NIFTI award supported through APTA
What questions do you hope to answer with your research?
Currently, a substantial gap exists in our understanding of the impact vestibular hypofunction has on patient well-being. As researchers and clinicians, we rely upon laboratory and clinically based outcomes that may fail to capture changes in a patient’s participation and community-based performance. This study will provide a comprehensive assessment of the impact unilateral vestibular loss has on community-based performance and determine how well laboratory and clinical outcomes represent true community-level participation.
What brought you to physical therapy research?
I had long been interested in science and had a desire to examine critical questions, but I was first drawn to physical therapy research during my DPT training. In the final year of my curriculum I acquired an internal award that allowed me to complete a project that ultimately led to publication. I found this to be a highly compelling experience and felt that research would provide me the greatest opportunity to have a positive lasting impact in physical therapy. From that point forward, I knew I wanted to pursue research that would enhance the profession.
How will you use the award funding?
I will use the award funding to support my project focused on characterizing laboratory, clinical, and community-based outcomes in people with unilateral vestibular hypofunction. Additionally, this funding will afford me the opportunity to continue to pursue an independent research career. I will do this by applying for future grant applications and gaining additional training in vestibular physiology/rehabilitation and the use of wearable sensors to monitor changes in human movement. Receiving the NIFTI will give me an outstanding start in my early career and help my transition into becoming an independent researcher.
Where do you see the physical therapy profession going in the future?
The physical therapy profession is a central component of the health care system; by adopting models for the management of chronic disease and aging populations I believe it will remain so. Specifically, I believe that by implementing the use of technologies that allow for monitoring individuals during community-based activities we will gain a much greater understanding of the impact different conditions have on participation-level outcomes. As therapists gain access to this technology and data, we will be able to tailor our interventions to best suit the needs of the patient and better understand the long-term effects of our treatment.
Sarah M. Schwab, PT, DPT
University of Cincinnati
Recipient of a PODS I Scholarship, made possible by the APTA Scholarship Fund.
What questions do you hope to answer with your research?
Meaningful motor tasks require an individual to appropriately respond to variable task demands under changing contexts. My research seeks to answer questions about upper extremity motor control in children and adolescents with cerebral palsy under varying contextual conditions by exploring whether certain contextual situations enhance motor performance, and how this knowledge can be used to facilitate meaningful movement.
What brought you to physical therapy research?
As a clinician, I have witnessed the extraordinary ability of physical therapy to transform the lives of patients. That being said, I appreciate that our profession is not satisfied with "good-enough." Physical therapy is an evidence-driven profession, always seeking to improve. I think we can always strive to be better and provide better interventions for our patients, particularly for diagnoses such as cerebral palsy, in which our interventions currently produce modest effects at best.
Where do you see the physical therapy profession going in the future?
It is my hope that physical therapy continues to be an evidence-driven profession with an enhanced emphasis on dynamical systems theory, perception-action research, and nonlinear methods. Such theories and tools have tremendous potential to enhance interventions we provide for individuals with disabilities. I also am looking forward to increased diversity in both research and practice, working to ensure that opportunities exist for all people in our profession.
Rich Severin PT, DPT
Board-Certified Cardiovascular & Pulmonary Clinical Specialist
University of Illinois-Chicago
Recipient of a PODS II Scholarship funded by the APTA Scholarship Fund
What questions do you hope to answer with your research?
I hope to better characterize respiratory muscle performance in morbidly obese patients; in particular, how potential changes in respiratory muscle performance influence physiological responses to exercise and other health-related outcomes. I also hope to identify how measures of respiratory muscle performance can be used as a screening tool for postoperative complications and how respiratory muscle training can potentially attenuate the risk of postoperative complications (mainly pulmonary) after weight-loss surgery.
What brought you to physical therapy research?
Ever since I started physical therapy school I had hoped to pursue a career in research and earn a PhD in addition to my DPT. While my research interests have changed from those earlier times, the motivation has remained similar. I’m fascinated by the amazing things observed in the clinic and the complexities of the human body. I’ve always been a fairly curious individual, and research is a great way to harness that curiosity into something productive that can also help people.
Where do you see the physical therapy profession going in the future?
I would like to see the physical therapy profession move toward more applied and basic science research, even getting into genomics. More evidence is emerging supporting the benefits of movement and exercise on our health; even down to the cellular and genetic level. As the movement profession we should be taking ownership of this area of research and leading from the front. I’ve been fortunate to be involved in such studies during my doctoral training and I hope that this becomes more common in our profession.
Jason Sharpe, PT, DPT
Board-Certified Orthopaedic Clinical Specialist
University of Utah
Recipient of a PODS II Scholarship funded by the APTA Scholarship Fund
What questions do you hope to answer with your research?
I want to understand what influences patients to choose physical therapy and the impact of that decision on patient outcomes, including their subsequent medical utilization. Our understanding of patient choice will provide the foundational knowledge needed to develop a shared decision-making intervention to direct patients who choose not to use physical therapy—even though likely to benefit from it—toward physical therapy.
What brought you to physical therapy research?
My interest in physical therapy research started early in my career while I was working in an outpatient orthopedic physical therapy private practice. In this clinic, the majority of our patients were experiencing chronic symptoms and frequently received care from several health care practitioners before physical therapy. I believed that some patients should have been using physical therapy earlier in their episode of musculoskeletal care to reduce the rates of chronic pain development. To achieve this goal, I decided to pursue a research career examining patients’ choice to use physical therapy, including how to more effectively direct physical therapy care for patients with musculoskeletal conditions.
Where do you see the physical therapy profession going in the future?
Physical therapists have an opportunity to reinforce themselves as the preferred provider for exercise-based interventions, a cost-effective treatment for a wide variety of musculoskeletal diagnoses and conditions influencing movement. By establishing our role in the management of musculoskeletal conditions and conditions influencing movement, we will be able to leverage direct access and improve care for patients throughout the health system.
'Bedrest is Bad': New #everyBODYmoves Campaign Is Combatting Hospital Immobility
Experts agree that immobility can harm patients in hospital, postacute care, and other settings. According to researchers, bedrest can have many negative effects:
- Muscle mass decreases by ~1.5%¬–2% per day during bed rest.
- Risk for development of thromboembolic disease increases.
- Increased risk for atelectasis may contribute to pneumonia.
- Raising the head of the bed causes greater pressure on the skin in the sacral region.
- One study found 61 of 155 patients who survived a critical illness had contractures.
Movement can ameliorate these effects, but for patients in hospital settings that often takes encouragement. And sometimes health care providers need to be reminded about their role in promoting movement.
Enter the #everyBODYmoves campaign, a 3-day event designed to encourage providers to make movement a priority and encourage the sharing of best practices and ideas, including an Online Global Summit focused on immobility harm, July 10-12, 2019. (Additional information in the Q&A below.)
For details, #PTTRANSFORMS spoke with Michael Friedman, PT, MBA, director of Johns Hopkins Activity and Mobility Promotion (AMP) and director of strategic program development in the Department of Physical Medicine and Rehabilitation at Johns Hopkins Medicine.
#PTTRANSFORMS: What is the #everyBODYmoves campaign?
Michael Friedman: It's a campaign developed by Johns Hopkins Medicine to raise awareness and put focus on the immobility harm in the hospital and postacute care. The campaign has brought together different groups around the country and around the world that we have had the good fortune to interface with while developing and disseminating our Activity and Mobility Promotion solutions. We have been successful in positioning hospital immobility as a harm just like deep vein thrombosis (DVT) or falls, and felt we could assist other organizations in raising awareness across disciplines—because you can’t address immobility if your organization doesn't realize it is a problem.
#PTTRANSFORMS: You presented on this topic at the recent congress of the World Confederation for Physical Therapy. Can you tell us about that?
MF: The presentation focused on the need to systematically address hospital immobility harm. Beyond having presenters from the United States, the Netherlands, the United Kingdom, and Australia, what I really enjoyed was that presenters included physical therapy, administration, nursing, and physician perspectives. Each perspective included an element focused on barrier assessment, measurement, training, and engagement. At Johns Hopkins we believe that it is essential to assess and measure mobility across disciplines—physicians, nurses, therapists—using a common tool and to be able to communicate a patient's progress to both the care team and the patient. My colleagues from around the world and across disciplines reinforced for me the importance of a global community working together to solve a common problem—and there you have it, #everyBODYmoves.
#PTTRANSFORMS: It's about shifting the culture or the organization mindset.
MF: It's an entire shift from a culture of immobility. Evidence demonstrates that bedrest is bad for every outcome there is. The July 10-12 summit hopefully will provide a jumping off point or accelerant for organizations to initiate or expand formal mobility programs.
The focus of this whole campaign is simple. You can participate in 3 ways.
- Establish a Mobility-a-thon: Over 3 days, what can you do to make mobility a priority in a patient's care plan? Can you get them up more? Can you get them up for 3 meals a day? What can you do to just make mobility a priority? That's it.
- Share your best practices on social media, patient success stories. Just use #everyBODYmoves and #EndPJparalysis to join the conversation.
- Attend the free online conference, which includes hours of content from around the world. Visit http://bit.ly/everybodymoves for conference details and free resources to support your campaigns and communicate with your teams.
#PTTRANSFORMS: How does this campaign extend to long-term care facilities or skilled nursing facilities?
MF: This approach works in postacute care, long-term care, and also home health care. Sedentary behavior is bad. We should all exercise more than we do. But if you're confined to the home or have a chronic illness, it becomes that much harder, and the cycle of comorbidity, debility, and disease accelerates. As a patient, you might say, "I'm sick, I just need to sit in bed and rest." Maybe you're on pain medication. We as providers need to think about all those barriers to movement and collectively develop solutions, no matter the setting.
#PTTRANSFORMS: How do you balance the concern about falls with the concern about immobility?
MF: Inherently, safe mobility would mean no falls, but we instead have been focused on core measure. Therefore, the easiest way not to have to record a fall in the hospital is for the patient not to get out of bed, but then they're more likely to get a pressure ulcer or pneumonia. When they leave the hospital, they're weaker and more likely to have a fall at home.
This is an unintended consequence of falls regulation and misaligned incentives.
There is an article on this topic called "The tension between promoting mobility and preventing falls in the hospital" that I encourage people to read.
#PTTRANSFORMS: What can a PT who's not in a decision-making position do to promote this type of initiative?
MF: To get things to stick, you need to push them to leadership and get your organization invested in it. Patient stories are so important. If you can bring patient stories forward and tie them to your other initiatives, feed them up through your managers and decision makers, you can turn a single patient interaction into a campaign.
Another thing you can do specifically as a PT is engage the rest of the care team across disciplines. Most patients in the hospital are not seen by a physical therapist and don’t need to be, but how can you still add value for those patients? You need to be thinking: I’m a consultant, I’m the expert on mobility. What can I recommend to the rest of the health care team to do when I’m not in the room?
For the patients you are seeing, you see them maybe for a half hour to 45 minutes. What's happening the other 23 hours of the day? What's happening on the days you're not going to see them? If individual staff PTs can start thinking, "What is the mobility plan for this patient when I'm not here?"—that's a huge start.
#PTTRANSFORMS: What is the most important takeaway?
MF: The single most important thing about the #everyBODYmoves campaign is that it allows an opportunity for rehab providers to engage other disciplines and communicate how important mobility is. Awareness, awareness, awareness.
These 3 days are just a start. To develop this as a full plan, you do need a systematic quality improvement approach. But the first steps are building awareness, engaging your organization, and understanding what you can do as an individual. Immobility is a harm and needs to be not only a rehab imperative but a quality and safety imperative just like any other. If we accomplish that, the rest will move in the right direction.