Thesis (Ed. D.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains viii, 164 p. : ill. Includes abstract. Includes bibliographical references (p. 115-123).

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Little research has explored the dilemmas of practice experienced by practitioners working with rehabilitation clients who are assimilating disabilities, resulting from injury or chronic conditions, into their lives. Consequently, there is limited literature to support educational initiatives or clinicians' decision-making in these settings. Accordingly, this qualitative study was designed to explore 'expert' physical therapists' perceptions of dilemmas of practice in rehabilitation settings. Using an ethnographic design, multiple interviews were conducted over a period of six months with each of ten participants. The researcher's theoretical background and 'insider' role were thoroughly explicated. Interpretive analysis was grounded in three overarching themes that emerged from the participants' accounts and compared with relevant theoretical constructs and research in physical therapy and other health professions. In the first theme the 'authority' of the concept of evidence-based practice as it is currently promoted within physical therapy was questioned. A need was identified to develop rigorous alternative sources of 'evidence' to support current practice that are more congruent with the multifactorial and client-centred nature of rehabilitation service provision. A second theme explored situations interpreted as causing moral distress in which the participants found themselves prevented from acting effectively on behalf of the clients, as a result of admission and discharge decisions and perceived misuse of rehabilitation resources within the organization and health system. The third theme related to the advantages and disadvantages of being involved with the interdisciplinary team. A lack of understanding of different professional philosophies of practice was perceived as a contributing factor to conflict and miscommunication. These themes are related to issues of professional accountability and suggest that physical therapy needs to develop a clearly articulated philosophy and conceptual models, including the concept of client-centred practice, that would reflect practice, serve to guide research and promote interdisciplinary collaboration. Alternative sources of 'best' evidence need to be developed that more realistically reflect complex 'practice' knowledge. In addition, the profession needs to commit to developing a comprehensive ethics curriculum offered in education programs and through interdisciplinary learning opportunities, by which physical therapists will be better prepared for the moral deliberations inherent in their professional role.

Little research documents the impact of communication on the relationship between the physical therapist and the older patient. As key health professionals, physical therapists need to know the degree to which a therapeutic relationship is occurring with the older adults they treat, and what aspects of the communication process can be improved to effectively meet the needs of this unique patient population. This exploratory study examines the relationships between older adults’ perceptions of physical therapists’ patient-centered communication (PCC), and their satisfaction with communication and physical therapy treatment (SPT). The sample consisted of 40 participants from 4 different physical therapy sites, including a hospital-based outpatient department, an outpatient aquatics practice, a sports-based outpatient clinic, and a home health company. The findings indicate that physical therapists’ use of PCC behaviors, especially clarity, empathy, listening, humor, and immediacy was positively associated with older adults’ satisfaction with communication and with physical therapy care.

<p>The aim of the current study was to determine the relationship between low back pain and physical activity levels among nurses in Kanombe Military Hospital (KMH), as well as other confounding factors leading to low back pain. A quantitative, cross-sectional and descriptive design was used to conduct the study. The study population and sample included all clinical nurses in all the departments/wards at KMH (excluding three nurses doing administrative work only and the four who participated in the pilot study). A total of 133 nurses participated in the study and data was collected using three self administered questionnaires. The first one requested socio-demographic data, followed by the International Physical Activity Questionnaire (IPAQ) which examined the physical activity levels of nurses, and lastly the Nordic Musculoskeletal Disorder Questionnaire which examined low back pain prevalence. A response rate of 122 (92%) was obtained.</p>

Shoulder dysfunction is frequently treated and persistent symptoms are common. Differential diagnosis of shoulder injuries can be challenging and knowledge of a diagnosis alone does not appear to be enough information to predict outcomes. Determination of a set of factors that predict outcome would assist clinicians in making the most effective treatment decision for patients with shoulder pain. The purposes of this dissertation were to investigate patient-clinician agreement in an orthopedic population of patients with shoulder pain and to determine what combination of factors best predicts positive patient-reported outcome following standardized rehabilitation in patients with shoulder pain. In the first study, it was determined that patient-clinician agreement was moderate to good. This further supports the use of patient reported outcomes as an appropriate approximation of “true” outcome. In the second study, patient-nominated functional limitations were reduced to 14 categories for inclusion as candidate predictors in the prediction model. In the third study, we observed that the combination of absence of neck pain, shorter duration of symptoms and report of exercise as a functional limitation were associated with greater odds of positive clinical outcome following 6 weeks of standardized rehabilitation. Due to limited sample size, generalizations cannot yet be made to other samples. Future investigation of this model in a larger sample and subsequent external validation in a separate sample are necessary to further develop the model for clinical use.