Cause, Prevalence, and Response to Occupational Musculoskeletal Injuries Reported by Physical Therapists and Physical Therapist Assistants.Key Words: Musculoskeletal musculoskeletal /mus·cu·lo·skel·e·tal/ (-skel´e-t'l) pertaining to or comprising the skeleton and muscles. mus·cu·lo·skel·e·tal adj. Relating to or involving the muscles and the skeleton. injury, Occupational injury, Physical therapy. An occupational injury can be defined as an injury that results from a work-related event or from a single instantaneous in·stan·ta·ne·ous adj. 1. Occurring or completed without perceptible delay: Relief was instantaneous. 2. exposure in the work environment leading to death, lost work time, medical treatment other than first aid, loss of consciousness, work restriction, or transfer to another job.[1] A Bureau of Labor Statistics Bureau of Labor Statistics (BLS) A research agency of the U.S. Department of Labor; it compiles statistics on hours of work, average hourly earnings, employment and unemployment, consumer prices and many other variables. investigation of occupational hazards occupational hazard n. a danger or risk inherent in certain employments or workplaces, such as deep-sea diving, cutting timber, high-rise steel construction, high-voltage electrical wiring, use of pesticides, painting bridges, and many factories. in health care settings showed that injury rates among health care workers are high.[1] The injury rate among hospital workers, for example, has been estimated to be twice that of other service industries.[2] Activities involving patient contact are highly correlated cor·re·late v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates v.tr. 1. To put or bring into causal, complementary, parallel, or reciprocal relation. 2. with occupational injuries among health care workers.[3] High levels of patient contact, as well as other variables in the health care environment that are thought to cause injuries, are common in the field of physical therapy. The practice of physical therapy requires the performance of many labor-intensive la·bor-in·ten·sive adj. Requiring or having a large expenditure of labor in comparison to capital: "Intrigue and subversion are labor-intensive undertakings" George F. Kennan. tasks related to the delivery of patient care. Such activities include lifting, bending, twisting, reaching, performing manual therapy, and maintaining awkward positions for a prolonged pro·long tr.v. pro·longed, pro·long·ing, pro·longs 1. To lengthen in duration; protract. 2. To lengthen in extent. period of time.[4] Therefore, physical therapists (PTs) and physical therapist assistants (PTAs) are susceptible to musculoskeletal injuries. A number of researchers[3,5-12] have investigated occupational injuries within health care settings (Tab. 1). The majority of these researchers have focused on nurses and nurses' aides. The results of these studies indicate that between 6% and 67% of health care workers studied in a variety of settings have experienced a work-related injury.[3,5-12]
Table 1.
Literature Review(a)
Study Population Body Part
Wilkinson et al[5] Health care workers Not specified
Nelson and Olson[3] Health care workers 20.2%(*) involved the
finger
8.8%(*) involved the
back
Myers et al[6] Hospital nursing Back
aides
Home health aides
Smith and White[7] Home health care Back
workers Other regions
Schwartz et al[8] Emergency medical An extremity
technicians Back
Stubbs et al[9] Nurses Low back
Harber et al[10] Hospital nurses Low back
Vasiliadou et al[11] Nurses Low back
Arad and Ryan[12] Nurses Low back
Study Injury Percentage
Wilkinson et al[5] Nurses=30.16 per 100
person-years
Nelson and Olson[3] 60 injuries per 100
full-time equivalents
(FTEs)
Myers et al[6] 5.9/100 FTEs
15.4/100 FTEs
Smith and White[7] 45%
14%
Schwartz et al[8] 9.8% (23.7/100 FTEs)
10.3 % (24.8/100 FTEs)
Stubbs et al[9] 53%
Harber et al[10] 52% over the
previous 6 mo
Vasiliadou et al[11] 67%
Arad and Ryan[12] 42% within the
previous month
Study Other Findings
Wilkinson et al[5]
Nelson and Olson[3] 21%(*) were sprain/
strain
20%(*) during
transferring/
lifting/repositioning
residents
Myers et al[6] 68.5%(*) occurred
during a planned
activity
31.5%(*) occurred
during a spontaneous
activity
Smith and White[7] 83% of agencies had
policies and
education/training
back care/protection
Schwartz et al[8] 26%(*) occurred
during a fall
67%(*) occurred while
lifting
Stubbs et al[9]
Harber et al[10] 12%(*) required
hospitalization
or > 1 visit to a
physician
Vasiliadou et al[11] 48%(*) missed work
62%(*) took medication
Arad and Ryan[12]
(a) Asterisk (1) See Asterisk PBX. (2) In programming, the asterisk or "star" symbol (*) means multiplication. For example, 10 * 7 means 10 multiplied by 7. The * is also a key on computer keypads for entering expressions using multiplication. (*) indicates percentage includes only those respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. reporting an injury. Molumphy et al[13] conducted one of the first studies concerned with the incidence of work-related low back pain (LBP LBP In currencies, this is the abbreviation for the Lebanese Pound. Notes: The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion. ) among PTs. They found that 29% of the 344 therapists surveyed reported work-related LBP. Their results indicated that the onset of work-related LBP occurred most frequently within the first 4 years of professional practice. The LBP was severe enough for 49% of those reporting pain to seek treatment from a physician and for 18% of the respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. to change work settings. Additionally, 41% of the respondents used sick leave, and 17% of the respondents decreased patient contact time. Scholey and Hair[14] studied the incidence of back pain in the United Kingdom among PTs as compared with other occupations (control group). There were no differences between the 2 groups for lifetime prevalence, annual prevalence, annual incidence, and point prevalence In epidemiology, point prevalence is a measure of the proportion of people in a population who have a disease or condition at a particular time, such as a particular date. It is like a snap shot of the disease in time. for LBP. Bork et al[4] investigated the prevalence of work-related musculoskeletal disorders Musculoskeletal disorders (MSDs) can affect the body's muscles, joints, tendons, ligaments and nerves. Most-work related MSDs develop over time and are caused either by the work itself or by the employees' working environment. (WMD WMD white muscle disease. ) during a 12-month period and factors that may be associated with these disorders among PTs. The 3 most common areas of injury reported by the 928 therapists who returned the survey instrument were the low back (45%), the wrist and hand (29.6%), and the upper back (28.7%). Lilting or transferring patients was identified as the factor most likely to be associated with the development of WMD. Treating a large number of patients in 1 day, working in awkward positions, working in the same position for long periods of time, and performing manual orthopedic orthopedic /or·tho·pe·dic/ (-pe´dik) pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopedics. techniques were also considered "major problems." Based on the literature, it appears that, although PTs have knowledge of and clinical expertise in musculoskeletal injuries, this does not grant them immunity immunity, ability of an organism to resist disease by identifying and destroying foreign substances or organisms. Although all animals have some immune capabilities, little is known about nonmammalian immunity. from developing WMD. Our study was designed to add information and increase our understanding of occupational musculoskeletal injuries beyond that of the previously published studies regarding PTs. In particular, in contrast to the study by Bark et al,[4] we surveyed both PTs and PTAs and attempted to obtain information on responses to injury and how work habits or work settings were changed as a result of injury. The purpose of our study was to examine the causes, prevalence, and response to occupational musculoskeletal injuries reported by PTs and PTAs. Method Sample and Procedure A total of 1,000 PTs and PTAs (500 each) were randomly selected from the 1996 American Physical Therapy Association The American Physical Therapy Association (APTA) is a national professional organization representing more than 66,000 members. Its goal is to foster advancements in physical therapy practice, research, and education. (APTA APTA American Physical Therapy Association. ) membership list representing members from all 50 states employed in a broad spectrum of practice settings. Although the equal numbers of PTs and PTAs selected do not reflect the ratio of PTs to PTAs in the Association, injury rates were not hypothesized to be related to APTA membership. A survey questionnaire was mailed to the PTs and PTAs selected from the membership list, and they were asked to complete the questionnaire if they had at least 2 years of experience in practice. Those with fewer than 2 years of clinical experience were encouraged to pass the questionnaire on to a PT or PTA PTA or parent-teacher association: see parent education. colleague who met this qualification. A cover letter was mailed along with the questionnaire to explain the purpose of the study and to assure confidentiality. A self-addressed stamped envelope A self-addressed stamped envelope (SASE), or just stamped addressed envelope (SAE) in the UK, is often just that: an envelope with the sender's name and address on it, with affixed paid postage and mailed to a company or private individual. was provided to facilitate a high response rate. A reminder postcard was sent to all randomly selected PTs and PTAS 1 week after the initial mailing, and a second questionnaire was sent to those who had not responded 3 weeks after the initial mailing. The envelopes were number coded to facilitate follow-up follow-up, n the process of monitoring the progress of a patient after a period of active treatment. follow-up subsequent. follow-up plan on respondents and, upon return, were separated from the enclosed en·close also in·close tr.v. en·closed, en·clos·ing, en·clos·es 1. To surround on all sides; close in. 2. To fence in so as to prevent common use: enclosed the pasture. questionnaire and discarded dis·card v. dis·card·ed, dis·card·ing, dis·cards v.tr. 1. To throw away; reject. 2. a. To throw out (a playing card) from one's hand. b. . Instrumentation instrumentation, in music: see orchestra and orchestration. instrumentation In technology, the development and use of precise measuring, analysis, and control equipment. The survey instrument was a self-administered 2-page questionnaire composed of predominately closed-ended Closed-ended may refer to:
tr.v. e·lic·it·ed, e·lic·it·ing, e·lic·its 1. a. To bring or draw out (something latent); educe. b. To arrive at (a truth, for example) by logic. 2. information pertaining per·tain intr.v. per·tained, per·tain·ing, per·tains 1. To have reference; relate: evidence that pertains to the accident. 2. to job-related musculoskeletal injuries. Respondents who had been injured in·jure tr.v. in·jured, in·jur·ing, in·jures 1. To cause physical harm to; hurt. 2. To cause damage to; impair. 3. were asked about the type of injury incurred and the body part affected, the activity being performed at the time of injury, the work setting in which the injury occurred, and whether the injury was reported and a physician was consulted. They were also asked whether there was time lost from work as a result of the injury, what activities caused symptoms to recur, and whether the injury caused the respondent to alter his or her work habits, reduce patient contact hours, or change employment setting. The initial questionnaire was developed based on a literature review and preliminary interviews with 15 practicing PTs and PTAS who met the sampling criteria. The questionnaire was then reviewed by a panel of 5 PTs and PTAS with 5 or more years of experience. Revisions were based on the recommendations made by the panel. We believe these revisions established face and content validity content validity, n the degree to which an experiment or measurement actually reflects the variable it has been designed to measure. . A final version of the questionnaire was prepared prior to mailing in an effort to corroborate To support or enhance the believability of a fact or assertion by the presentation of additional information that confirms the truthfulness of the item. The testimony of a witness is corroborated if subsequent evidence, such as a coroner's report or the testimony of other as well as expand on the work of Bork et al.[4] To determine the reliability of the survey responses, we asked a small sample of convenience consisting of 7 PTs and 6 PTAS who had experienced occupational musculoskeletal injuries to complete the questionnaire. Two weeks later, they again completed the questionnaire. Test-retest Test-retest is a statistical method used to examine how reliable a test is: A test is performed twice, e.g., the same test is given to a group of subjects at two different times. percentage of agreement was calculated and found to average 98% (range=92%-100%). The areas of the questionnaire most susceptible to discrepancy DISCREPANCY. A difference between one thing and another, between one writing and another; a variance. (q.v.) 2. Discrepancies are material and immaterial. were the demographics section (notably height and weight reports) and, in the recent injuries section regarding altered work habits as a result of the injury, responses to the question "What do you do differently?" Data Analysis A cross-sectional cross section also cross-sec·tion n. 1. a. A section formed by a plane cutting through an object, usually at right angles to an axis. b. A piece so cut or a graphic representation of such a piece. 2. design was used in an effort to determine what the PTs and PTAs thought were the causes and prevalence of their occupational musculoskeletal injuries. Prevalence rates for the 2-year period were calculated by dividing the number of PTs and PTAs who reported any injury by the total number of respondents. Prevalence was calculated by dividing the number of respondents with injuries of specific anatomical anatomical /ana·tom·i·cal/ (an?ah-tom´i-kal) pertaining to anatomy, or to the structure of an organism. an·a·tom·i·cal or an·a·tom·ic adj. 1. Concerned with anatomy. 2. areas by only those reporting an injury. The same method was used to calculate prevalence rates for the activity being performed when injured, setting of injury occurrence, response to injury, exacerbation ex·ac·er·ba·tion n. An increase in the severity of a disease or in any of its signs or symptoms. ex·ac of symptoms, and changed work habits as a result of injury for PT and PTA respondents. All questionnaires were analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. using the Statistical Package for Social Sciences (SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. version 4.1 for IBM (International Business Machines Corporation, Armonk, NY, www.ibm.com) The world's largest computer company. IBM's product lines include the S/390 mainframes (zSeries), AS/400 midrange business systems (iSeries), RS/6000 workstations and servers (pSeries), Intel-based servers (xSeries) ) computer software program.(*) Descriptive statistics descriptive statistics see statistics. were used to compare the demographics of the respondents in our survey with the demographics reported in APTA's 1996 Active & Affiliate Membership Profile Report.[15] Nonrespondents were compared with respondents by job title and sex. The mean, standard deviation In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. , and range were calculated for age, height, weight, years of experience, and hours per week in direct patient care of all respondents. Chi-square distributions chi-square distribution in statistical terms this is said of a variable with K degrees of freedom if it is distributed like the sum of the squares of K independent random variables each of which has a normal distribution with mean zero and variance of 1. were used to assess the statistical significance of observed differences among the subgroups by various work settings and personal characteristics. The Fisher exact 2-tail test, continuity correction In probability theory, if a random variable X has a binomial distribution with parameters n and p, i.e., X is distributed as the number of "successes" in n independent Bernoulli trials with probability p , and likelihood ratio were used to determine the level of statistical significance. Results Demographics Of the 1,000 survey instruments mailed, 667 were returned, producing a 67% response rate. Forty-four survey instruments were returned with inappropriate responses (eg, not meeting the criteria of having 2 years or more of experience) and had to be excluded from the study. Of the 623 usable USable is a special idea contest to transfer US American ideas into practice in Germany. USable is initiated by the German Körber-Stiftung (foundation Körber). It is doted with 150,000 Euro and awarded every two years. survey instruments, 370 were completed by PTs and 253 were completed by PTAs. The PTs and PTAs who responded were similar with respect to age, height, weight, and hours per week spent in direct patient care, but they were different in years of experience. Physical therapists had an average of 13 years of work experience, whereas PTAs had an average of 7 years of work experience. Additional descriptive and demographic information is presented in Tables 2 and 3. These findings indicate that our data were obtained from a subset A group of commands or functions that do not include all the capabilities of the original specification. Software or hardware components designed for the subset will also work with the original. that closely resembles the sex ratio according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. APTA's 1996 Active & Affiliate Membership Profile Report.[15] Table 2. Descriptive Information of Physical Therapist (PT) Respondents to Questionnaire
PT
Respondents Age (y) Height (m)
(n=370) [bar]X SD Range [bar]X SD Range
All 37.9 9.5 24-66 1.70 0.92 1.33-2.00
Female (72%) 37.4 9.1 24-62 1.66 0.07 1.33-1.86
Male (28%) 39.1 10.3 24-66 1.80 0.08 1.53-2.00
PT
Respondents Weight (kg) Years as PT
(n=370) [bar]X SD Range [bar]X SD Range
All 58.9 15.0 45.5-136 13.0 9.0 2-40
Female (72%) 63.0 10.8 45.5-130 12.0 8.8 2-40
Male (28%) 83.8 14.0 52.3-136 13.4 9.6 2-39
Hours per Week
in Direct Patient
PT Respondents Care
(n=370) [bar]X SD Range
All 30.5 12.2 0-68
Female (72%) 28.5 11.3 0-55
Male (28%) 35.4 13.2 2-68
Table 3. Descriptive Information of Physical Therapist Assistant (PTA) Respondents to Questionnaire
PTA
Respondents Age (y) Height (m)
(n=253) [bar]X SD Range [bar]X SD Range
All 35.1 8.6 22-74 1.68 0.09 1.45-1.96
Female (83%) 34.8 8.2 22-64 1.66 0.07 1.45-1.84
Male (17%) 36.8 10.4 23-74 1.81 0.08 1.58-1.96
PTA
Respondents Weight (kg) Years as PTA
(n=253) [bar]X SD Range [bar]X SD Range
All 69.1 15.4 45.5-136 7.3 6.2 2-40
Female (83%) 65.9 13.3 45.5-136 7.4 6.0 2-40
Male (17%) 86.3 14.3 56.8-111 6.9 7.3 2-30
Hours per Week
in Direct Patient
PTA Respondents Care
(n=253) [bar]X SD Range
All 30.5 10.6 0-80
Female (83%) 30.2 10.4 0-80
Male (17%) 32.0 11.6 0-58
Survey instruments were returned by PTs in 48 states and 2 overseas locations. Survey instruments were returned by PTAs in 41 states. The 3 states with the most PT respondents were California California (kăl'ĭfôr`nyə), most populous state in the United States, located in the Far West; bordered by Oregon (N), Nevada and, across the Colorado River, Arizona (E), Mexico (S), and the Pacific Ocean (W). (10%), Pennsylvania Pennsylvania (pĕnsəlvā`nyə), one of the Middle Atlantic states of the United States. It is bordered by New Jersey, across the Delaware River (E), Delaware (SE), Maryland (S), West Virginia (SW), Ohio (W), and Lake Erie and New York (7%), and Texas (5%). The states with the most PTA respondents were Texas (8%), Ohio (7%), and Michigan Michigan (mĭsh`ĭgən), upper midwestern state of the United States. It consists of two peninsulas thrusting into the Great Lakes and has borders with Ohio and Indiana (S), Wisconsin (W), and the Canadian province of Ontario (N,E). and Florida Florida, state, United States Florida (flôr`ĭdə, flŏr`–), state in the extreme SE United States. A long, low peninsula between the Atlantic Ocean (E) and the Gulf of Mexico (W), Florida is bordered by Georgia and (5%). The study results that follow are reported as percentages, with 100% representing all PTs or PTAs who reported an occupational musculoskeletal injury. Four hundred fifteen (67%) of the remaining 623 respondents reported they had not sustained a musculoskeletal injury within the last 2 years. The remaining 208 respondents (33%) reported they had sustained such an injury. Thirty-two percent of all PT respondents and 35% of all PTA respondents reported sustaining a musculoskeletal injury. Injuries to Anatomical Areas The PT and PTA respondents reported the highest level of occupational injury in the low back (62% and 56%, respectively). The PTs reported the upper back and the wrist and hand equally as their second most prevalent site of injury (23%). The PTAs also reported the upper back as their second most prevalent site of injury (28%) (Fig. 1). The highest injury prevalence was seen in PTs and PTAs aged 21 to 30 years who worked between 41 and 50 hours per week. Years of experience had no effect on injury prevalence in PTs ([chi square chi square (kī), n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies. ] = 8.13, P [greater than or equal to] .087) or PTAs ([chi square] = 0.75, P [is greater than or equal to] .94). Figure 1. Percentage of respondents who reported sustaining a musculoskeletal injury, missing work, and visiting a physician compared by anatomical area. Asterisk (*) indicates only those respondents reporting an injury (PTs=119, PTAs=88). PT=physical therapists, PTA=physical therapist assistant.
Percentage(*) Percentage(*)
With Officially
Injury Reporting
Anatomical
Area PT PTA PT PTA
Neck 18 16 33 54
(PTs=21, PTAs=14)
Shoulder 14 18 38 44
(PTs=16, PTAs=16)
Upper Back 23 28 35 52
(PTs=27, PTAs=24)
Elbow 11 6 15 40
(PTs=13, PTAs=5)
Lower Back 62 56 42 40
(PTs=73, PTAs=49)
Wrist/Hand 23 15 31 62
(PTs=27, PTAs=13)
Hip/Thigh 2 0 100 0
(PTs=2, PTAs=0
Knee 3 6 25 40
(PTs=4, PTAs=5)
Ankle/Foot 3 2 33 100
(PTs=3, PTAs=2)
Percentage(*) Percentage(*)
Missing Visiting
Work Time Physician
Anatomical
Area PT PTA PT PTA
Neck 33 54 57 62
(PTs=21, PTAs=14)
Shoulder 25 38 44 47
(PTs=16, PTAs=16)
Upper Back 24 30 31 43
(PTs=27, PTAs=24)
Elbow 31 0 38 20
(PTs=13, PTAs=5)
Lower Back 28 19 31 36
(PTs=73, PTAs=49)
Wrist/Hand 27 8 32 54
(PTs=27, PTAs=13)
Hip/Thigh 0 0 0 0
(PTs=2, PTAs=0)
Knee 25 20 50 20
(PTs=4, PTAs=5)
Ankle/Foot 33 0 33 100
(PTs=3, PTAs=2)
Injury by Practice Setting The prevalence of injury at a specific anatomical location varied with the practice setting. For example, PTs practicing in a rehabilitation rehabilitation: see physical therapy. environment at the time of injury reported more low back injuries (75%) than their colleagues reporting injuries in outpatient outpatient /out·pa·tient/ (-pa-shent) a patient who comes to the hospital, clinic, or dispensary for diagnosis and/or treatment but does not occupy a bed. out·pa·tient n. settings (64%), hospitals (63%), or skilled nursing facilities skilled nursing facility n. Abbr. SNF An establishment that houses chronically ill, usually elderly patients, and provides long-term nursing care, rehabilitation, and other services. (SNFs) (52%). Physical therapist assistants injured in hospitals reported having the most low back injuries (65%) when compared with PTAs in SNFs (54%), outpatient settings (50%), or rehabilitation settings (36%). Practice setting proved to be an important factor for both PTs and PTAs who sustained wrist or hand injuries ([chi square] = 11.11, P [greater than or equal to] .049 for PTs; [chi square] = 25.29, P [greater than or equal to] .0001 for PTAs). Thirty-eight percent of PTs in an SNF SNF abbr. skilled nursing facility SNF solids-not-fat; a comment on the composition of milk. and 32% of PTs in an outpatient setting reported sustaining a wrist or hand injury, as compared with only 13% of PTs injured in hospitals and 0% injured performing home-based care. Three PTAs, who account for all (100%) PTAs injured in private practice, reported sustaining an injury to the wrist or hand. This percentage is in comparison with the 6% of PTAs who reported sustaining a wrist or hand injury in an SNF (2 out of 31 PTAs). Injury Type The most common type of injury reported by PT and PTA respondents was a muscle strain (69% and 78%, respectively). For PTs, ligament ligament (lĭg`əmənt), strong band of white fibrous connective tissue that joins bones to other bones or to cartilage in the joint areas. The bundles of collagenous fibers that form ligaments tend to be pliable but not elastic. sprain sprain, stretching or wrenching of the ligaments and tendons of a joint, often with rupture of the tissues but without dislocation. Sprains occur most commonly at the ankle, knee, or wrist joints, causing pain, swelling, and difficulty in moving the involved joint. (28%) and vertebral ver·te·bral adj. 1. Of, relating to, or of the nature of a vertebra. 2. Having or consisting of vertebrae. 3. Having a spinal column. disk involvement (16%) followed muscle strain in order of reported prevalence. For PTAs, tendinitis tendinitis or tendonitis Inflammation of a tendon sheath, due to irritation of this thin, filmy tissue by overuse of the tendons, which slide within them, or to bacterial infection. (15%) and ligament sprains (14%) followed muscle strain in order of reported prevalence. The only statistically significant finding was that PTs had more ([chi square] = 5.08, P [is less than or equal to] .024) ligamentous sprains than PTAs had. Activity Being Performed When Injured Both PT and PTA respondents reported on activities they were performing at the time of injury. The 3 most prevalent activities were transferring a patient (PTs = 30%, PTAs = 36%), lifting (PTs = 25%, PTAs=24%), and responding to an unanticipated or sudden movement by a patient (PTs = 24%, PTAs = 33%). Performing manual therapy was the fourth most prevalent activity for PTs at 21% (Tab. 4). Table 4. Percentage of Respondents Who Reported That Specific Activities Caused an Occupational Injury(a)
PT PT PTA
Activity That Caused Injury (%) (%)(b) (%)
Transferring a patient 30 26(c) 36
Lifting 25 NA 24
Responding to an unanticipated or
sudden movement by a patient 24 15 33
Performing manual therapy 21 18 11
Performing repetitive tasks 15 15 9
Maintaining a position for a prolonged
period of time 14 18 16
Working in an awkward or cramped
position 13 18 19
Working when physically fatigued 13 12 6
Bending or twisting 10 15 10
Slipping, tripping, falling 3 NA 6
Instructing a patient 2 NA 2
Applying modalities 1 NA 1
(a) PT = physical therapist, PTA = physical therapist assistant, NA = not applicable. (b) Respondents in study by Bork et al[4] indicated job factor descriptions that were perceived as problematic for the development of work-related musculoskeletal disorders. (c) Lifting and transferring patients. Responses to Injury Thirty-six percent of PT respondents and 49% of PTA respondents stated that they officially reported their injury to the appropriate person in their workplace. Thirty-four percent of PTs and 44% of PTAs saw a physician for their injury, and 25% of PTs and 23% of PTAs reported losing a half day or more from work as a result of their injury. Figure 1 displays the responses to injury in terms of anatomical area. Of all body parts affected, the most marked response was caused by injury to the neck. When chi-square chi-square (ki´skwar) see under distribution and test. chi-square n. analysis was used to compare injury responses with anatomical area of injury, a statistically significant ([chi square] = 5.14, P [is less than or equal to] .023) number of PTs (57%) reported visiting a physician after a neck injury and a significant ([chi square] = 6.93, P [is less than or equal to] .0085) number of PTAs (54%) reporting missing work time due to neck injury. A significant number of PTAs ([chi square] = 3.82, P [is less than or equal to] .051) with back injury reported their injuries to an appropriate person where they worked. No significant findings were observed with other injury response and injury area comparisons. Seventy percent of the PT respondents and 68% of the PTA respondents who sustained a work-related musculoskeletal injury reported that their symptoms were exacerbated by clinical practice. Physical therapists reported that the top 4 activities that caused recurrence recurrence /re·cur·rence/ (-ker´ens) the return of symptoms after a remission.recur´rent re·cur·rence n. 1. of symptoms were maintaining a position for a long period of time (36%), lifting (35%), transferring a patient (30%), and performing manual therapy (28%). The top 4 activities that caused recurrence of symptoms in PTAs were lifting (26%), maintaining a position for a long period of time (24%), transferring a patient (24%), and working in an awkward or cramped cramped adj. 1. Uncomfortably small or restricted: cramped living quarters. 2. Difficult to read, especially for being crowded into a small space: cramped handwriting. position (20%) (Tab. 5). Table 5. Percentage of Respondents Who Reported That Job Activities Caused Their Symptoms to Recur(a) Exacerbating Activity PT (%) PTA (%) Maintaining a position for a prolonged period of time 36 24 Lifting 35 26 Transferring a patient 30 24 Performing manual therapy 28 15 Performing repetitive tasks 20 14 Working in awkward or cramped positions 18 20 Reaching/working away from the body 18 11 Bending or twisting 16 11 Performing overhead activities 10 9 Squatting 2 6 Walking 2 4 Climbing stairs 0 4 (a) Percentage includes only those respondents reporting all injury. PT=physical therapist, PTA=physical therapist assistant. Seventy-nine percent of the PT respondents and 81% of the PTA respondents reported that they altered their work habits as a result of their injury. When chi-square analysis was used to compare altered work habits with anatomical area of injury, a statistically significant ([chi square] = 9.18, P [is less than or equal to] .0024) number of PTAs with low back injuries (94%) reported altering their work habits as a result of injury. Physical therapists cited improvements in body mechanics body mechanics n. The application of kinesiology to the use of proper body movement in daily activities, to the prevention and correction of problems associated with posture, and to the enhancement of coordination and endurance. (50%), increased use of other personnel (43%), and changing work position frequently (24%) as the top 3 changes they made in their work habits. Physical therapist assistants also reported improvements in body mechanics (50%) as their most common change in work habits, followed by changing work positions frequently (36%) and increased use of other personnel (33%) (Tab. 6). Table 6. Percentage of Respondents Who Reported Altering Work Habits as a Result of Experiencing an Occupational Musculoskeletal Injury(a) Altered work Habits PT (%) PTA (%) Use improved body mechanics 50 50 Increase use of other personnel 43 33 Change working position frequently 24 36 Avoid lifting 16 13 Increase use of mechanical aids 14 10 Take more rest breaks or pauses during the workday 13 11 Decrease manual therapy 13 10 Stop working when hurt or when symptoms occur 11 13 Encourage patient responsibility for carrying out treatment 10 19 Change work schedule (overtime, irregular shifts, length of workday) 4 3 Increase administrative time, decrease patient care time 4 2 (a) PT = physical therapist, PTA = physical therapist assistant. Ninety two percent of the PTs and 93% of the PTAs reported that they had not limited their patient contact time as a result to their injury, and 85% of the PTs and 86% of the PTAs stated that they did not limit their area of practice after sustaining an injury. More PTAs (14%) than PTs (8%) stated that they would consider a job change because of their injury or risk of sustaining another injury (Fig. 2). [Figure 2 ILLUSTRATION OMITTED] Discussion Almost a third of the respondents (PTs=32%, PTAs=35%) in our study reported sustaining an occupational musculoskeletal injury. Of those respondents with an injury, 34% of the PTs and 44% of the PTAs sought a physician for their injury. We attribute this difference to the possibility that PTs would tend to self-diagnose more or seek help from a colleague who specialized spe·cial·ize v. spe·cial·ized, spe·cial·iz·ing, spe·cial·iz·es v.intr. 1. To pursue a special activity, occupation, or field of study. 2. in musculoskeletal injuries rather than take the time to visit a physician. In addition, 25% of the PTs and 23% of the PTAs reported losing a half day or more from work as a result of their injury. Bork et al[4] obtained data quite different than ours from their sample of 1,000 PTs who graduated from The University of Iowa Not to be confused with Iowa State University. The first faculty offered instruction at the University in March 1855 to students in the Old Mechanics Building, situated where Seashore Hall is now. In September 1855, the student body numbered 124, of which, 41 were women. . They found that less than 3% of PTs injured in any one anatomical area sought help from a physician or missed work as a result or a WMD. A possible explanation for the difference in results was that the operational definition of"injury" was different in the 2 studies. Bork et al[4] asked their subjects whether they "suffered a job-related ache, pain, discomfort Discomfort may refer to pain, an unpleasant sensation, or to suffering, an unpleasant feeling or emotion. , etc," whereas we asked our subjects, "Have you suffered a musculoskeletal injury due to work?" An "ache, pain, or discomfort" seems intuitively more minor than an occupational musculoskeletal injury. Therefore, we believe that fewer respondents in the study by Bork et al[4] would seek treatment from a physician or miss work as result of an injury. We found that a large number of PTs (57%) reported visiting a physician after a neck injury compared with injuries to other anatomical areas. In addition, a large number of PTAs (54%) missed at least a half day of work following a neck injury when compared with other injuries. We did not ask our subjects, but further investigation could be initiated to determine whether there were any radiating ra·di·ate v. ra·di·at·ed, ra·di·at·ing, ra·di·ates v.intr. 1. To send out rays or waves. 2. To issue or emerge in rays or waves: Heat radiated from the stove. symptoms or neurological neurological, neurologic pertaining to or emanating from the nervous system or from neurology. neurological assessment evaluation of the health status of a patient with a nervous system disorder or dysfunction. signs associated with this high response rate. In contrast to our study, Bork et al[4] found that PTs who reported sustaining an injury to the low back were more likely to miss work. The high prevalence of occupational musculoskeletal injury to the low back among PTs (62%) and PTAs (56%) in our study is similar to results found by other researchers investigating the prevalence of LBP among health care workers. Bork et al[4] found a 12-month prevalence of LBP of 45%. Molumphy et al[13] found the prevalence of job-related LBP to be 29% when they surveyed 344 PTs. In a study by Scholey and Hair,[14] the prevalence of LBP in 243 PTs in Great Britain Great Britain, officially United Kingdom of Great Britain and Northern Ireland, constitutional monarchy (2005 est. pop. 60,441,000), 94,226 sq mi (244,044 sq km), on the British Isles, off W Europe. The country is often referred to simply as Britain. was found to be 38%. When compared with previous studies,[6,7,9,10] our results confirm that PTs and PTAs have one of the highest prevalence rates for back injury of those health care workers reporting injuries. The anatomical location of the injury showed similar trends to those reported by Bork et al.[4] As in the study by Bork et al[4], the low back, the upper back, and the wrist and hand were the most frequently injured body parts among the PTs and PTAs in our study. Our reports of knee, ankle, and foot injuries, however, were substantially lower than those found by Bork et al.[4] Again, we attribute this finding to the differences in the survey instruments used in the 2 studies. For example, PTs may experience an ache or discomfort in their feet, ankles, and knees from prolonged periods of standing or poor body mechanics, but this ache or discomfort may not be classified as a true injury from a single instantaneous event. There are similarities between the findings of previous studies and our findings in regard to the activities that respondents were engaged in when injured on the job.[3,4,12,14] The most common activities found to cause occupational musculoskeletal injury were transferring patients, lifting, and responding to an unanticipated or sudden movement by a patient. Bork et al[4] also found other problematic activities to be treating a large number of patients in 1 day, working in awkward or cramped positions, not enough rest breaks, and working in the same position for long periods. Unlike previous research, we investigated the type of injury sustained by PTs and PTAs. Nelson and Olson Olson may refer to:
Sprain refers to damage or tearing of ligaments or a joint capsule. Strain refers to damage or tearing of a muscle. were the most frequently reported injuries among all health care workers in a rural health facility. The most common type of injury reported in our study was a muscle strain. We also found that PTs reported having more ligament sprains than PTAs reported having. We asked the PTs and PTAs in our study what type of injury they experienced; we did not ask for a medical diagnosis. This approach may have led to reporting of self-diagnoses, which we believe could have led to questionable data regarding injury type. Physical therapists practicing in rehabilitation settings and PTAs practicing in hospital settings at the time of injury reported more low back injuries than their colleagues in other practice settings reported. Physical therapists and PTAs are more likely to perform patient transfers and lifts (activities commonly found to be a mechanism of low back injury) in the settings where patients are more dependent. Practice setting proved to be a relevant factor for PTs sustaining wrist or hand injuries when compared with other setting or injury profiles. Thirty-eight percent of PTs in SNFs and 32% of PTs in outpatient settings reported experiencing a wrist or injury. We expected to find a high prevalence rate for wrist and injuries in outpatient facilities, where there may be a higher likelihood of manual therapy techniques being performed. Bork et al[4] found that PTs who regularly performed manual therapy were 3.5 times more likely to sustain a wrist or hand work-related injury than PTs who did not routinely perform manual therapy. We are unsure as to the reason for the high prevalence of wrist and hand injuries in SNFs. A high percentage of PTs (70%) and PTAs (68%) who reported sustaining work-related musculoskeletal injuries also reported having their symptoms exacerbated by clinical practice. The top 3 activities that caused recurrence of symptoms for both PTs and PTAs were maintaining a position for a long period of time, lifting, and transferring a patient. A high percentage of PTs also reported that performing manual therapy caused symptoms to recur. In our study, a large percentage of PTs (79%) and PTAs (81%) reported that they altered their work habits as a result of their injury. These figures indicate that the respondents felt that a change in work habits was required in order to decrease the risk of another injury. These figures also demonstrate that a large percentage of respondents believed they had some control over the recurrence of their injury. Tile work habits most commonly changed were body mechanics, increased use of other personnel, and changing work position frequently. A very small percentage of respondents (PTs = 4%, PTAs = 2%) increased their administrative time and decreased patient contact time. Poor body mechanics often results in some insult in·sult n. A bodily injury, irritation, or trauma. insult Medtalk noun Any stressful stimulus which, under normal circumstances, does not affect the host organism, but which may result in morbidity, when it to the back. Because a high percentage of PTs (62%) and PTAs (56%) reported a low back injury, it was not surprising to see a change in body mechanics as the most cited area of improvement. The vast majority of PTs and PTAs surveyed did not limit their patient contact time, limit their area of practice, or consider changing jobs due to their injury or risk of another injury. This finding demonstrates their tendency to work through injuries without disrupting their daily routine or career. In our opinion, future research should be directed toward determining the efficacy of intervention A procedure used in a lawsuit by which the court allows a third person who was not originally a party to the suit to become a party, by joining with either the plaintiff or the defendant. programs that might be used to decrease the incidence of work-related musculoskeletal injuries for PTs and PTAs. To determine whether job-related injuries differ among clinical specialty areas, further research is needed. Another idea for future studies is to take a closer look at the relationship of injuries sustained by manual therapists. Conclusions The prevalence of work-related musculoskeletal injuries reported by PT and PTA respondents was highest in the low back and the upper back. The most common type of injury reported by both PT and PTA respondents was a muscle strain. The 3 most prevalent activities performed at the time of the injury were transferring a patient, responding to an unanticipated or sudden movement by a patient, and lifting. Seventy percent of the PT respondents and 68% of the PTA respondents who reported sustaining a work-related musculoskeletal injury also reported that their symptoms were exacerbated by clinical practice. They reported that the top 3 activities that caused recurrence of symptoms were maintaining a position for a long period of time, lifting, and transferring patients. For PTs, performing manual therapy was also highly reported. Most of the PTs and PTAs who reported sustaining an injury admitted to altering their work habits as a result of the injury. The most cited area of change was improvement in body mechanics. Labor-intensive tasks appear to make PTs and PTAs susceptible to occupational musculoskeletal injuries. Because our findings indicate that few PTs and PTAs change their level of patient contact of change jobs flue flue see underflue. to injury, occupational injury preventions programs should be developed to limit PTs' and PTAs' susceptibility susceptibility the state of being susceptible. Refers usually to infectious disease but may be to physical factors such as wetting or to psychological factors such as harassment. to work-related injuries. (*) SPSS Inc, 444 N Michigan Ave AVE Avenue AVE Average AVE Alta Velocidad Espanola (train between Madrid and Seville) AVE Alta Velocidad Española (Spanish: High Speed Train) AVE Audio Video Entertainment AVE Advertising Value Equivalent , Chicago Chicago, city, United States Chicago (shĭkä`gō, shĭkô`gō), city (1990 pop. 2,783,726), seat of Cook co., NE Ill., on Lake Michigan; inc. 1837. , IL 60611. References [1] Occupational Injuries and Illnesses in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. by Industry, 1992. Washington Washington, town, England Washington, town (1991 pop. 48,856), Sunderland metropolitan district, NE England. Washington was designated one of the new towns in 1964 to alleviate overpopulation in the Tyneside-Wearside area. , DC: US Department of Labor, Bureau of Labor Statistics; 1992. [2] Stellman JM. Safety in the health care industry. Occup Health Nurs. 1982;30:17-21. [3] Nelson ML, Olson DK. Health care worker incidents reported in a rural health care facility: a descriptive study. AAOHN AAOHN American Association of Occupational Health Nurses J. 1996;44:115-122. [4] Bork BE, Cook TM, Rosecrance JH, et al. Work-related musculoskeletal disorders among physical therapists. Phys Ther. 1996;76:827-835. [5] Wilkinson WE, Salazar MK, Uhl JE, et al. Occupational injuries: a study of health care workers at a northwestern health science center and teaching hospital. AAOHN J. 1992;40:287-293. [6] Myers A, Jensen RC, Nestor D, et al. Low back injuries among home health aides compare with hospital nursing aides Noun 1. nursing aide - someone who assists a nurse in tasks that require little formal training nurse's aide auxiliary, aide - someone who acts as assistant . Home Health science center Quarterly. 1993;14:149-155. [7] Smith WA, White MC. Home health care: occupational health issues. AAOHN J. 1993;41:180-184. [8] Schwartz RJ, Benson L, Jacobs LM. The prevalence of occupational injuries in EMTs in New England New England, name applied to the region comprising six states of the NE United States—Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. The region is thought to have been so named by Capt. . Prehospital and Disaster Medicine. 1993:8:45-50. [9] Stubbs DA, Buckle PW, Hudson MP, et al. Back pain in the nursing profession, I: epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause and pilot methodology. Ergonomics ergonomics, the engineering science concerned with the physical and psychological relationship between machines and the people who use them. The ergonomicist takes an empirical approach to the study of human-machine interactions. . 1983; 26:755-765. [10] Harber P, Billet E, Gutowski M, et al. Occupational low-back pain in hospital nurses J. Occup Med. 1985;27:518-524. [11] Vasiliadou A, Karvountzis GG, Soumilas A, et al. Occupational low-back pain in nursing staff in a Greek hospital. J Adu Nurs. 1995;21:125-130. [12] Arad D, Ryan MD. The incidence and prevalence in nurses of low-back pain: a definitive survey exposes the hazards. Aust Nurses J. 1986;16:44-48. [13] Molumphy M, Unger B, Jensen GM, Lopopolo RB. Incidence of work-related low back pain in physical therapists. Phys Ther. 1985;65:482-486. [14] Scholey M, Hair M. Back pain in physiotherapists involved in back care education. Ergonomics. 1989;32:179-190. [15] 1996 Active & Affiliate Membership Profile Report. Alexandria, Va: American Physical Therapy Association; 1996. Appendix. Occupational Injuries in Physical Therapy Survey Questionnaire(a) Section A: Recent Injuries--(If you have had more than one injury in the last 2 years, please answer the following questions in regard to the one injury that most interfered with your clinical practice.)
1. Have you sustained any musculoskeletal injuries due to your
work within the last 2 years (since Fall 1994)?
-- Yes -- No If no, please go to Section B: Demographics
2. What body part(s) was(were) affected? Please check all
that apply.
-- Neck
-- Upper Back (thoracic)
-- Lower Back (lumbar/sacral)
-- Shoulder
-- Elbow
-- Wrist and Hand
-- Hip/Thigh
-- Knee
-- Ankle and Foot
3. What type of injury was it? Please check all that apply.
-- Degeneration
-- Dislocation
-- Fracture
-- Ligament Sprain
-- Muscle Strain
-- Neuropathy
-- Synovitis
-- Tear
-- Tendinitis
-- Vertebral Disk Involvement
-- Other
4. What activity were you doing when you were injured?
-- Applying Modalities
-- Bending or Twisting
-- Instructing a Patient
-- Lifting
-- Maintaining a Position for
a Prolonged Period of Time
-- Performing Manual Therapy Techniques
-- Performing Repetitive Tasks
-- Responding to an Unanticipated
or Sudden Movement by a Patient
-- Slipping, Tripping, or Falling
-- Transferring a Patient
-- Working in Awkward or Cramped Position
-- Working When Physically Fatigued
-- Other
5. In what type of setting did the injury occur?
-- Academic Institution (postsecondary)
-- Hospital
-- Industry
-- Outpatient Facility
-- Patient's Home (home care)
-- Private Physical Therapy Office
-- Rehabilitation Center
-- School System (preschool, primary, and secondary)
-- Skilled Nursing Facility (ECF, ICF)
-- Other
6. Did you officially report the injury?
-- Yes -- No
7. Did you see a physician for the injury?
-- Yes -- No
8. Did you lose a half day or more from work as a result of
the injury?
-- Yes -- No
9. Since your injury, have your symptoms been exacerbated by
clinical practice?
-- Yes -- No
If yes, what activities cause your symptoms to recur? Please
check all that apply.
-- Bending or Twisting
-- Lifting
-- Maintaining a Position for
a Prolonged Period of Time
-- Performing Overhead Activities
-- Performing Manual Therapy Techniques
-- Performing Repetitive Tasks
-- Reaching/Working Away From the Body
-- Climbing Stairs
-- Squatting
-- Transferring a Patient
-- Walking
-- Working in Awkward or Cramped Positions
-- Other
10. Has the injury caused you to alter your work habits?
-- Yes -- No
If yes, what do you do differently? Please check all
that apply.
-- Avoid Lilting
-- Change Working Position Frequently
-- Change Work Schedule (overtime,
irregular shifts, length of workday)
-- Decrease Manual Techniques
-- Encourage patient Responsibility
for Carrying Out Treatment
-- Increase Administrative Time;
Decrease Patient Care Time
-- Increase Use of Mechanical Aids
-- Increase Use of Other Personnel
-- Stop Working When Hurt or When
Symptoms Occur
-- Take More Rest Breaks or Pauses
During the Workday
-- Use Improved Body Mechanics
-- Other
11. Have you limited your patient contact time as a result
of the injury?
-- Yes -- No
12. Have you limited your area of practice to avoid sustaining
another injury?
-- Yes -- No
13. Are you considering changing jobs because of this injury or
risk of another injury?
-- Yes -- No
Section B: Demographics
1. Are you a -- Physical Therapist or -- Physical Therapist
Assistant?
2. How many years have you been practicing as a physical
therapist/physical therapist assistant?
-- Years
3. In what state do you currently practice? --
4. How many hours in a typical work week do you devote to direct
patient care? -- hours
5. Male -- Female --
6. Age -- years
7. Height -- feet -- inches
8. Weight -- pounds
THANK YOU VERY MUCH FOR YOUR TIME AND ASSISTANCE WITH OUR RESEARCH!! (a) ECFs = extended care facility, ICF (Internet Connection Firewall) The built-in firewall in Windows XP. It provides a stateful inspection of packets which accepts only responses to requests originated by the user. = intermediate care facility. NL Holder, PT, is Staff Physical Therapist, Penn Therapy and Fitness at Westampton, 798 Woodlane Sq, Suite 11, Westampton, NJ 08060 (USA) (nholder@mail.med.upenn.edu). Address all correspondence to Ms Holder. HA Clark, PT, is Staff Physical Therapist, Lehigh Valley Hospital Lehigh Valley Hospital is a network of three hospitals in Allentown and Bethlehem, serving as the primary hospital system for the Lehigh Valley, in Pennsylvania, United States. The network consists of three hospitals and six health centers. , Allentown, Pa. JM DiBlasio, PT, is Staff Physical Therapist, Vermont Vermont (vərmŏnt`) [Fr.,=green mountain], New England state of the NE United States. It is bordered by New Hampshire, across the Connecticut R. Sports Medicine sports medicine, branch of medicine concerned with physical fitness and with the treatment and prevention of injuries and other disorders related to sports. Knee, leg, back, and shoulder injuries; stiffness and pain in joints; tendinitis; "tennis elbow"; and Center, Rutland, Vt. CL Hughes, PT, is Staff Physical Therapist, Pinnacle pinnacle (pĭn`ĭkəl), minor architectural motif of vertical tapering shape, usually crowning a pier, buttress, or gable. Although sometimes it appears in Renaissance design, as in the Certosa di Pavia, it is almost exclusively a medieval Health System, Harrisburg, Pa. JW Scherph PT, is Staff Physical Therapist, VA Medical Center, Bay Pines, Fla. L Harding, PT, OCS OCS - Object Compatibility Standard , is Assistant Professor, Department of Physical Therapy, Temple University, Philadelphia, Pa. KF Shepard, PhD, PT, FAPTA FAPTA Fellows of the American Physical Therapy Association , is Professor, Department of Physical Therapy, Temple University. Concept and research design were provided by Holder, Clark, DiBlasio, Hughes, Scherpf, Harding, and Shepard; writing, by Holder, DiBlasio, Hughes, Scherpf, and Shepard; data collection, by Holder, DiBlasio, Hughes, and Scherpf, with collection tool construction by Shepard; data analysis, by Holder, Hughes, and Shepard; project management, by Shepard; fund procurement The fancy word for "purchasing." The procurement department within an organization manages all the major purchases. , by Hughes; clerical/secretarial support, by Holder; and consultation (including review of manuscript manuscript, a handwritten work as distinguished from printing. The oldest manuscripts, those found in Egyptian tombs, were written on papyrus; the earliest dates from c.3500 B.C. prior to submission), by Holder and Hughes. Ms Holder, Ms Clark, Mr DiBlasio, Ms Hughes, and Mr Scherpf were students in the Master of Physical Therapy The Master of Physical Therapy (MPT) is a postbaccalaureate degree conferred upon successful completion of an accredited Physical therapy professional education program. Successful candidates are then qualified to apply for and take the Physical Therapy national licensure exam (in Program at Temple University at the time this study was conducted in partial fulfillment ful·fill also ful·fil tr.v. ful·filled, ful·fill·ing, ful·fills also ful·fils 1. To bring into actuality; effect: fulfilled their promises. 2. of their degree requirements. This study was approved by the Institutional Review Board of Temple University. This article was submitted May 18, 1998, and was accepted March 7, 1999. |
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