Lower Extremity Lymphedema is a chronic condition of characterized by swelling of body part. It is typically treated with Complex Decongestive Therapy (CDT) to reduce volume. While volume reduction is the primary goal of the treatment, third party payers often require the presence of activity limitations in order to qualify for coverage. The purpose of this dissertation was to identify the types of impairments and functional limitations that occur in this population. A second goal was to determine if volume reduction from CDT is sufficient to resolve the impairments and activity limitations associated with lymphedema, or if traditional physical therapy is necessary to resolve them. In Chapter 2, we performed a study to validate several tools to measure the change in volume that occurred with CDT. Also, a reliability study was performed on the Perometer. The results of this study found that the Perometer had excellent test-retest reliability ( ICC = .99) and that the change measured by the Perometer agreed better with the change measured by the "gold standard" water displacement method, (ICC = .99) than did the change measured by the circumferential tape method (ICC = .92). In Chapter 3, we conducted a cross sectional analysis to determine the baseline impairments and activity limitations associated with lower limb lymphedema. Subjects scored below normal values in all measures of impairments and activity limitations including active range of motion to ankle dorsiflexion and knee flexion, Heel Rise, 30 Second Chair test, Berg Balance Score (BBS), Limits of Stability (LOS), Extended Timed Get Up and Go (ETGUG), Limitation in Mobility Activities Test (LIMAT) and SF-36 Medical Outcomes Study (SF-36). Subjects with severe vs. moderate lymphedema demonstrated scored significantly worse on all tests except ETGUG. Limb Volume was correlated at a fair level with all impairment and activity limitation measures except SF36 which produced a strong correlation. Impairment measures correlated strongly with activity limitations. In Chapter 4, we performed a longitudinal study to address several questions. Were reductions in limb volume related to improvements in impairments and activity limitations? What proportion of subjects completing 2- weeks of CDT continued to have balance impairments or activity limitations severe enough to increase the risk of falling? In subjects at increased risk of falling, does a 4-week standard physical therapy intervention produce improvements in both impairments and the activity limitations? The change in limb volume was significant after the 2 week CDT intervention. However, the loss of volume was not strongly associated with an improvement in impairments or an increase in function over the two week or additional 4 week treatment intervention. Traditional physical therapy intervention produced significant improvements in activity limitations and body function impairments. In Chapter 5, we discussed the clinical and health care policy implications of this research. It was determined that the standard CDT treatment protocol was not sufficient to address impairments and activity limitations other than edema in subjects with lower limb lymphedema. A comprehensive evaluation of these patients requires a traditional physical therapy examination in addition to the volume evaluation to assess the associated impairments and activity limitations. Third party payer coverage guidelines require that the patient be educated to maintain the reduction in limb volume achieved by CDT. This study found a worsening of the edema occurred 4 weeks after termination of the CDT. Policy guidelines were originally developed for individuals with upper extremity lymphedema and may need to be modified for subjects with lower limb edema because of substantial differences in the types of impairments and limitations in mobility and function that occur when the lower limb is involved.

Thesis (Ph.D.)--Ohio University, August, 2004. / Includes bibliographical references (leaves 139-157)

AN ABSTRACT OF THE DISSERTATION OF MICHAEL A. STROUD, for Doctor of Philosophy degree in HEALTH EDUCATION, presented on MARCH 20, 2014, at Southern Illinois University Carbondale. TITLE: PHYSICAL THERAPISTS' CLINICAL PRACTICES REAGARDING INTRINSIC AND EXTRINSIC FALL RISK FACTORS AND THEIR ATTITUDES TOWARD THE USE OF EVIDENCE-BASED PRACTICE MAJOR PROFESSOR: Dr. Stephen Brown The phenomenon of falls among community-dwelling adults--coupled with an aging baby boomer generation and an increasing life expectancy--presents a significant concern for an increased number of unintentional deaths and injuries and their associated costs. The risk factors associated with falling are often categorized as intrinsic and extrinsic. Physical therapists have a unique opportunity to positively impact issues involving physical dysfunction and to educate their community-dwelling adult patients about the environmental risk factors and interventions that lessen their risk of falling. Abundant evidence-based research exists regarding interventions for the treatment and prevention of falls; however, this research indicates that physical therapists fail to consistently utilize evidence-based practice (EBP) in their daily clinical practices. The diffusion of innovations theory examines how innovations are adopted (Rogers, 2012). However, the innovation of EBP is not always adopted by physical therapists. Lack of time to conduct literature searches was the most common barrier noted by physical therapists for not adopting EBP (Jette et al., 2003; Fruth et al., 2010; Salbach, Jagial, Korner-Bitensky, Rappolt, & Davis, 2007). This study, which utilized a cross-sectional descriptive research design, provided insight into physical therapists' clinical practices regarding intrinsic and extrinsic fall risks in the treatment of community-dwelling adults aged 65 years and older. It examined physical therapists' attitudes and beliefs toward the use of EBP and identified the barriers to their adoption of it. The demographic data provided a descriptive overview of the study respondents. There were 3,523 potential physical therapist respondents, and the study's return rate was 9% (316 respondents. The majority of the respondents held doctoral degrees (49.4%), more than half (55.4%) worked in an outpatient physical therapy clinical setting, and approximately half indicated that they were American Physical Therapy Association (APTA)-certified instructors. The results of the study indicated that physical therapists who had more experience displayed a higher level of attention to clinical practices than those with less experience. The physical therapists who were APTA-certified clinical instructors demonstrated a higher level of attention to the intrinsic and extrinsic risks of falling than those who were not APTA-certified instructors. The physical therapists whose highest level of education was a doctorate placed greater importance on the utilization of EBP than respondents with a baccalaureate or master's degree. Although most physical therapists believe that the utilization of EBP holds significant value, they do not always access or apply it. Insufficient time for using EBP was the major barrier noted by most physical therapists. The results of this study concurred with those of previous studies regarding common barriers to physical therapists' adoption of EBP. Rehabilitation organizations may want to examine methods to promote the use of the most current physical therapy practices based on the evidence revealed in the literature and to explore options for improving staff access to and utilization of EBP research.

Purpose: The purpose of this work was identify key factors associated with inpatient physical therapy utilization and length of stay for patients with low back pain (LBP) in Florida hospitals. Rationale: Little is known about factors associated with inpatient physical therapy or length of hospitalization for patients with LBP. This group of works identified the key factors associated with inpatient physical therapy and long lengths of hospitalization for this patient population. Since physical therapy and reduced length of stay are known cost-reducers, identifying key factors may represent significant cost savings to the health care system. Methods: Several mixed method procedures were utilized to examine physical therapy utilization and length of hospitalization between the years of 1992 and 2014. Policy, patient and hospital characteristics, as well as, hospital procedures during a patient’s stay were examined as contributors to either physical therapy utilization or length of hospitalization. Conclusion: Many factors are associated with inpatient physical therapy utilization and length of stay for patients with LBP in Florida hospitals.

One of the goals for physical therapist graduates of professional entry-level education programs is development of the ability to practice effectively in the present health care environment. Another goal is for graduates to develop the ability to continue to learn and grow as professionals throughout their careers, and to contribute to the evolution of their profession in the future. The clinical reasoning and associated experiential learning of new graduates can be viewed as a practical demonstration of both of these goals. This research explored student physical therapists? understanding and learning of clinical reasoning during their professional entry education. / PhD Doctorate

Physical Therapy has been developing in Taiwan for over half a century. However, the transformation in Taiwan population structure, the implementation of national health insurance, the legislation of physical therapist regulation in 1995 and the change of the education system stimulated the blossom of the physical therapy profession from four to five hundred certified physical therapists initially to twenty five hundred to date. This research devotes to the relationship between the job characteristics, potential of career development, and professional commitment of the practicing physical therapists. We approach the indicated part of professional commitment by these four elements; including professional identification, job involvement, intention of long-term involvement, advanced research and study. This research employed the following methods, descriptive statistics analysis, factor analysis, reliability analysis, independent t-test, one-way ANOVA, correlation analysis and regression analysis. We sent out a total of 1290 surveys and got 256 returned. There were 6 invalid surveys in returned ones. So we obtained 250 valid surveys. We acquired these results below: 1.Personal related variables suggest significant difference in professional commitment, partially legitimate. Age, education level, and annual income suggest no significant difference. Gender suggests significant difference in professional commitment; marriage suggests significant difference to job involvement. Job location suggests significant difference in job involvement. Attendance to professional conferences suggests significant difference in professional identification, job involvement, intention of long-term involvement and advanced research and study. 2.Job characteristics influences professional commitment significantly, a valid statement. Task variety, job autonomy and task identity also influence professional commitment significantly. 3.Potential of career development influences professional commitment significantly, a legitimate statement. Professional environment and possibility of independent practice influence professional commitment significantly.

Abstract Background. Physical therapists report inconsistent use of valid and reliable measures of walking post-stroke. Objective. To describe the methods physical therapists use to evaluate walking, reasons for selecting these methods, and the use of the evaluation results in clinical practice along the continuum of an organized system of stroke care. Methods. A qualitative descriptive study involving semi-structured telephone interviews of physical therapists in Ontario was conducted. A thematic analysis was performed. Results. Participants (n=28) used both standardized and non-standardized methods to assess walking. A hierarchy of factors influencing use of both methods was observed. Assessment results were commonly used for communication with other healthcare professionals or education of the patient. Conclusions. A variety of factors influence physical therapists to use standardized assessment tools. Future knowledge translation interventions should focus on these factors to improve the standardized assessment of walking post-stroke.

Abstract Background. Physical therapists report inconsistent use of valid and reliable measures of walking post-stroke. Objective. To describe the methods physical therapists use to evaluate walking, reasons for selecting these methods, and the use of the evaluation results in clinical practice along the continuum of an organized system of stroke care. Methods. A qualitative descriptive study involving semi-structured telephone interviews of physical therapists in Ontario was conducted. A thematic analysis was performed. Results. Participants (n=28) used both standardized and non-standardized methods to assess walking. A hierarchy of factors influencing use of both methods was observed. Assessment results were commonly used for communication with other healthcare professionals or education of the patient. Conclusions. A variety of factors influence physical therapists to use standardized assessment tools. Future knowledge translation interventions should focus on these factors to improve the standardized assessment of walking post-stroke.

Thesis (M.A.)--Georgia State University, 2006. / Title from title screen. Leslie Taylor, committee chair; Elizabeth Burgess, Frank Whittington, Jaye Atkinson, committee members. Electronic text (75 p. : ill. (some col.)) : digital, PDF file. Description based on contents viewed July 30, 2007. Includes bibliographical references (p. 62-66).

A dissertation presented in partial fulfilment of the requirements for the Masters Degree in Technology: Chiropractic, 2007. / To establish the profile of the typical patient presenting to private chiropractors in South Africa, in terms of: demographic data; characteristics of the presenting complaint; the knowledge levels of patients on the scope of chiropractic; the diagnosis of the patients; to compare this primary data to existing data from similar international studies. / M