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An analysis and comparison of the educational costs of clinical placements for occupational therapy, physical therapy, and speech pathology and audiology students.

The purpose of this paper is to describe the methodology and summarize the results of a study of the educational costs of clinical placement for students in occupational therapy, physical therapy, and speech pathology and audiology at The University of British Columbia. The sample represented 42.9% of the facilities offering occupational therapy placements, 41.4% of those offering physical therapy placements, and 52.4% of those offering speech pathology and audiology placements. During a 12-month period, these facilities provided 77.3% of the total clinical hours for the occupational therapy students, 65.1% for the physical therapy students, and 66.1% for the speech pathology and audiology students. Estimates of the number of hours of single-purpose and joint-purpose instructional activities and percentage estimates of direct-contact time were used as a basis for calculating the costs to facilities of accepting students for clinical placement. The methodology permitted comparisons of these costs across health disciplines. Both the methodology and the findings of this study can help government, educational institutions, and clinical facilities in defining policies and funding mechanisms for clinical training programs.

Audiology↗

Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial.

BACKGROUND: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. OBJECTIVE: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. DESIGN: Randomized, controlled trial. SETTING: Outpatient care setting in the Netherlands. PATIENTS: 183 patients, 18 to 70 years of age, who had had nonspecific neck pain for at least 2 weeks. INTERVENTION: 6 weeks of manual therapy (specific mobilization techniques) once per week, physical therapy (exercise therapy) twice per week, or continued care by a general practitioner (analgesics, counseling, and education). MEASUREMENTS: Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured. RESULTS: At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not statistically significant. CONCLUSION: In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.

Adolescent↗

Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial.

OBJECTIVES: The authors' goals were to compare the effectiveness of manual therapy (MT; mainly spinal mobilization), physical therapy (PT; mainly exercise therapy), and continued care by the general practitioner (GP; analgesics, counseling and education) over a period of 1 year. METHODS: One hundred eighty-three patients suffering for at least 2 weeks from nonspecific neck pain were randomized to receive a 6-week treatment strategy of MT once a week, PT twice a week, or GP care once every 2 weeks. The primary outcome measures were perceived recovery, severity of physical dysfunctioning, pain intensity, and functional disability. RESULTS: The differences between groups considered over 1 year were statistically significant (repeated measurements analyses P<0.001 to P=0.02) for all outcomes but borderline for the Neck Disability Index (P=0.06). Higher improvement scores were observed for MT for all outcomes, followed by PT and GP care. The success rate, based on perceived recovery after 13 weeks, was 72% for MT, which was significantly higher than the success rate for continued GP care (42%, P=0.001) but not significantly higher compared with PT treatment (59%, P=0.16). The difference between PT and GP approached statistical significance (P=0.06). After 1 year the success rates were 75%, 63%, and 56%, respectively, and no longer significantly different. CONCLUSIONS: Short-term results (at 7 weeks) have shown that MT speeded recovery compared with GP care and, to a lesser extent, also compared with PT. In the long-term, GP treatment and PT caught up with MT, and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-up.

Adolescent↗

Physical therapy rationale for physical therapy.

Physical therapy is applied to relieve airway obstruction and to decrease the ventilatory effects of increased resistance to flow. The most direct method for reducing resistance through airways and collateral channels for ventilation is to increase lung volume. It is possible to vary the distribution of alveolar volume and airflow by changing the gradient of pleural pressure and the inspiratory flows. Results of physical therapy are frequently difficult to assess, especially if the simplest of end points, such as volume of sputum and arterial blood gases, are used. For example, the volume of sputum may not accurately reflect mucociliary transport either during or after a period of sputum collection, especially if cough is encouraged. Furthermore, arterial blood gases, like measures of airway resistance, may be insensitive indicators of changes in peripheral airways, especially if homeostatic mechanisms for maintaining ventilation-perfusion relationships are effective.

Airway Obstruction↗

Mapping the literature of physical therapy.

Physical therapy is a fast growing profession because of the aging population, medical advances, and the public's interest in health promotion. This study is part of the Medical Library Association (MLA) Nursing and Allied Health Resources Section's project to map the allied health literature. It identifies the core journals in physical therapy by analyzing the cited references of articles in two established physical therapy journals, Physical Therapy and Archives of Physical Medicine and Rehabilitation, during the period 1991 through 1993. This bibliometric analysis also determines the extent to which these journals are covered by the primary indexing sources, Allied and Alternative Medicine (AMED), the Cumulative Index to Nursing and Allied Health Literature, EMBASE, and MEDLINE. In this study, fourteen journals were found to supply one-third of all references studied. Ninety-five journals provided an additional third of the references. MEDLINE rated the highest as the indexing tool of choice for these 109 journals. The study results can assist in collection development decisions, advise physical therapists as to the best access to their core literature, and influence database producers to increase their coverage of the literature important to physical therapy.

Abstracting and Indexing↗

A primer on physical therapy.

Physical therapy is an important component of today's health care system. Although physical therapists can be found in many inpatient and outpatient settings, they frequently treat patients with common musculoskeletal problems referred by primary care providers. The physical therapy consultation involves an examination by the physical therapist, diagnosis, prognosis, and initiation of a plan of care that includes specific interventions. Specific interventions include therapeutic exercise, functional training, manual techniques, fitting for assistive devices, application of physical agents such as heat or cold, and electotherapeutic modalities. This article will focus on the use of the physical therapy process for common musculoskeletal problems seen in primary care.

Humans↗

Rheumatoid arthritis. Present-day physical therapy.

Physical therapy is an important therapeutic agent for patients with rheumatoid arthritis. Well directed exercise balanced with rest is fundamental. Careful muscular reeducation is as important in the treatment of patients with arthritis as it is in caring for a patient with paralysis. Pain with slight malalignment and limitation in the joint will cause muscles to lose their sequence of action and so upset the rhythm of motion. Active exercise with a balanced use of assistance and resistance to movement, combined, as indicated, with traction upon the joint or stretching of constricted tissues may result in (1) stabilization of the joint, (2) increase in range of movement, (3) relaxation of antagonists, and (4) reduction of atrophy. The objectives of muscular exercise then are (1) reduction of pain, spasm and deformity, (2) development of muscular power, and (3) restoration of the normal rhythm of movement.

Arthritis↗

A model for establishing occupational therapy and physical therapy services in the public schools.

One procedure for the establishment of therapists in public schools and on management and administration teams in the State Department of Public Instruction, Division for Exceptional Children is discussed. A significant aspect of the procedure is a model for a working relationship between the Division for Exceptional Children and the Occupational Therapy and Physical Therapy Divisions in the Department of Medical Allied Health Professions in a School of Medicine.

Child↗