School-based physical therapy services and student functional performance at school

Spreading Standardized Documentation of Pediatric Occupational and Physical Therapy Dose: A Quality Improvement Initiative

IMPORTANCE

Clinicians and researchers can leverage clinical documentation of therapy services for quality improvement and research purposes. However, documentation is often institution specific and may not adequately capture the dose of therapy delivered, thus limiting collaboration.

OBJECTIVE

To implement documentation of pediatric occupational and physical therapy dose from one institution to another institution. Dose documentation includes the frequency, intensity, time, and type of interventions delivered (FITT Epic® Flowsheet) at each session.

DESIGN

Prospective time-series quality improvement study.

SETTING

Two large urban pediatric hospitals.

PARTICIPANTS

Occupational and physical therapy staff members.

INTERVENTION

Staff training and feedback loops utilizing existing groups.

OUTCOMES AND MEASURES

The process measure (number of available staff trained and using the FITT Epic Flowsheet over time) and the outcome measure (percentage of FITT Epic Flowsheets used for treatment visits each month) were analyzed using a statistical process control chart. The balancing measure (percentage of notes closed before 7 p.m. on the same day as the encounter) was analyzed using mean per month across three time periods.

RESULTS

Fifty-seven staff members (68%) attended formal training. On average, clinicians documented 90% of sessions using the FITT Epic Flowsheet after implementation. There was no change observed in the balancing measure.

CONCLUSIONS AND RELEVANCE

Documentation of dose was spread from one institution to another. Shared documentation will facilitate future collaboration for quality improvement and research purposes. Occupational therapy practitioners and leaders should consider implementing documentation with common dose elements. Plain-Language Summary: Occupational therapy documentation is often institution specific and may not adequately capture the dose of therapy (frequency, intensity, time) or types of interventions that were delivered, thus limiting opportunities for collaboration between institutions. This article adds to the literature on administrative supports for clinical and quality improvement research by illustrating a specific example of how documentation of dose can be shared from one institution to another. The data show that clinicians at one institution started using a new style of documentation using the FITT Epic® Flowsheet and shared discrete dose elements with another institution, creating new opportunities for collaboration. Shared documentation can facilitate future collaboration for quality improvement and research purposes.

Does the Impact of Technology Sustain Students’ Satisfaction, Academic and Functional Performance: An Analysis via Interactive and Self-Regulated Learning?

High-quality academic outcomes are required for students’ educational attainment and promote their desire to learn. However, not all educational sectors boast of the same, leading students to attain inferior outcome performances. The current study examines the impact of technology on student satisfaction, academic, and functional performance via the mediating factors of interactive and self-regulated learning. However, existing works focused less on technology and more on psychological learning factors, rendering mere acceptance of technology, proved to be useless. The present research investigates such mediators with existing technology resources and their impact on students’ overall growth. Research hypotheses are tested through structural equation modeling and applied to the data collected from 302 respondents via a structured questionnaire. In addition, the present study considers the collection of each student’s data across different universities, colleges, vocational and education institutions, mainly where students are involved in/using the technology when it comes to satisfaction, academic, and functional performance. The results indicated that the impact of technology via interactive learning has a significant influence on students’ satisfaction (β = 0.238, p < 0.05), academic performance (β = 0.194, p < 0.05), and functional performance (β = 0.188, p < 0.05). It is also noted that the impact of technology via self-regulated learning has positively contributed to satisfaction, academic, and functional performance. Our findings support the hypothesis and encourage students’ adaptability, engagement, and behavioral interactions stimulating the performance outcomes. The performance outcome of this research presents valuable information for decision-makers to articulate sustainable strategies and tactics in educational sectors.

Regional Differences in School-Based Physical Therapy: Examination of Therapist and Student Characteristics, Service Delivery, Activities, Interventions, and Outcomes

AimsThe aim of this study was to examine regional differences in school-based physical therapy practice focusing on the attributes of the school-based physical therapists and students; service delivery approaches, activities, and interventions; and student outcomes. Recognition of regional practices may decrease unnecessary variations, and assist with therapist clinical decision making and efforts to implement evidence-informed practice.MethodsA secondary data analysis of the PT COUNTS data was performed to compare physical therapist and student attributes; service delivery, activities, and interventions; and student outcomes across the Northeast, Southeast, Central, and Northwest regions of the United States.ResultsDifferences in the physical therapist and student characteristics, service delivery, activities, and interventions existed across the regions. There were no regional differences in outcomes when controlling for student functional level.ConclusionRegional differences in school-based practices may be expected and indicative of the influence of contextual factors including state and local policies and procedures that shape school-based service delivery and the characteristics of the therapists and students. Regional differences in practices may not have been of sufficient clinical magnitude to alter outcomes. Physical therapists can use the findings to reflect upon their individual decision making and practices.

Regional Differences in School-Based Physical Therapy Practice for Students Who Made Progress on 2 Outcome Measures

PURPOSE

This study examined whether regional differences exist in the provision of school-based physical therapy services for students who achieved positive progress and explored relationships between student outcomes and school-based physical therapy.

METHODS

Physical therapists developed student goals using Goal Attainment Scaling (GAS) and administered the School Function Assessment (SFA). Therapists documented activities, interventions, and type of service delivery provided weekly. Students were assigned to regions for analysis.

RESULTS

Student GAS goal attainment and progress on the SFA did not vary significantly among regions. The dosage of school-based physical therapy services, interventions, and activities varied.

CONCLUSIONS

There were regional differences that did not impact goal achievement. Further research is needed to identify the most efficient and effective interventions and dosage to support student outcomes.

Changing the Paradigm of School-Based Physical Therapist Service Delivery: Using Evidence to Support Intensive Intervention

PURPOSE

The purpose of this article is to highlight the paradigm shift away from the typical model of direct service delivery of consistent frequency and duration in the school setting to accommodate an intensive progressive resistive exercise intervention. School-based physical therapists describe how they applied an evidence-based intensive intervention with multiple students in an urban public school district.

SUMMARY OF KEY POINTS

The school-based physical therapists had to modify the typical service delivery model and overcome other challenges to implement this intensive intervention approach. Substantial improvements in strength and functional activities were observed in multiple students and measured across several months.

CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE

An intensive intervention model appears effective and feasible in the school setting. Evidence-based intervention approaches should be considered when the student could benefit.

VIDEO ABSTRACT

For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A339.

Relationship of School-Based Physical Therapy Services to Student Goal Achievement

PURPOSE

To explore the relationships of school-based physical therapy services to student goal achievement.

METHODS

One hundred nine physical therapists and 296 students participated in a practice-based study. Therapists formatted goals using goal attainment scaling and evaluated goal achievement. Using the School-Physical Therapy Interventions for Pediatrics system, therapists documented services weekly for 20 weeks. Group comparisons and logistic regressions were conducted.

RESULTS

For primary goals, no documented physical therapy services were associated with exceeding goal expectation. For posture/mobility goals, more minutes in self-care activities and services on behalf of the students were associated with exceeding goal expectation; use of cognitive and behavioral training interventions was associated with not exceeding goal expectation (P < .05). For recreation/fitness goals, greater use of functional strength and mobility for playground access and cognitive/behavioral interventions were associated with exceeding goal expectation (P < .05).

CONCLUSION

A limited number of physical therapy services was associated with exceeding goal expectation.

Documenting Physical Therapy Dose for Individuals With Cerebral Palsy: A Quality Improvement Initiative

PURPOSE

To describe the quality improvement (QI) activities used to improve treatment dose documentation for individuals with cerebral palsy (CP) and to discuss insights gained from this project.

METHODS

Global and smart aims were established and interventions were tested from January 2017 through February 2018 using Plan-Do-Study-Act cycles. Performance was tracked overtime using run and control charts.

RESULTS

The QI initiative resulted in a sustainable increase in percentage of dose elements present in the electronic medical record from 78% to 94%. Key drivers of improvement included (1) knowledge and awareness of dose, (2) clinician buy-in, (3) effective engagement of child and parent, (4) therapist knowledge of evidence-based treatments, (5) transparent and reliable documentation system, and (6) audit and clinician feedback.

CONCLUSIONS

QI methods provided the tools to improve workflow and increase dose documentation for individuals with CP.