Clinical research agenda.Adopted and promulgated prom·ul·gate tr.v. prom·ul·gat·ed, prom·ul·gat·ing, prom·ul·gates 1. To make known (a decree, for example) by public declaration; announce officially. See Synonyms at announce. 2. by APTA's Board of Directors (BOD BOD: see sewerage. ), the Clinical Research Agenda was the result of a series of conferences and editorial review processes in which large numbers of physical therapists participated. The Agenda was published in May 2000 (Clinical Research Agenda for Physical Therapy. Phys Ther. 2000; 80:499-513). APTA APTA American Physical Therapy Association. supports research that is conducted across all points on the continuum of health-related research. The BOD recognizes that the domains along this continuum should not be perceived as mutually exclusive Adj. 1. mutually exclusive - unable to be both true at the same time contradictory incompatible - not compatible; "incompatible personalities"; "incompatible colors" areas of knowledge and that research across the continuum is vital to the profession of physical therapy. In March 2005, the BOD passed P03-05-1849, Continuum of Research in Physical Therapy: The profession of physical therapy is committed to understanding and participating in basic science, mechanistic, translational, clinical, and health services research Health services research is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, , in order to provide patients/clients with the most current, appropriate, and effective management. The 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) has an obligation to foster leadership and participation in all research efforts related to the science of physical therapist practice. The science is inherently transdisciplinary and encompasses a seamless continuum of research from basic underlying mechanisms and theory to clinical application. The key questions confronting physical therapy require employment of the full range of methodological designs and approaches. The Clinical Research Agenda should be read in this context. The Agenda describes prototypical questions that are relevant to clinical practice--and that are answerable in the near-term--within the broad array of questions along the continuum of research germane ger·mane adj. Being both pertinent and fitting. See Synonyms at relevant. [Middle English germain, having the same parents, closely connected; see german2. to physical therapy. Additional specific questions, including basic and applied scientific inquiries, also could provide new knowledge that would enhance physical therapist practice. If the answers to additional research questions can be applied to clinical practice, those questions would then be consistent with the intent of the Agenda and can be legitimately included as part of the Agenda. 1. What is the usefulness of information derived from examination (history, review of systems, tests and measures) for patient classification that can be used to direct/guide intervention? Examples of potential research questions include the following: 1.1. What measures could be used to classify patients? * What factors can be used to classify patients with thoracic disorders? * What factors can be used to classify patients following a cerebrovascular accident cerebrovascular accident n. Abbr. CVA See stroke. cerebrovascular accident Stroke, cerebral hemorrhage Neurology Sudden death of brain cells due to ↓ O2 ? * Do motor control strategies differ in people with low back pain compared with people without low back pain, and, if so, how? 1.2. What are the psychometric psy·cho·met·rics n. (used with a sing. verb) The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and properties of tests and measures used for patient classification? * What are the relationships between self-report of function and observed measures? * What are the psychometric properties of performance-based and self-assessment measures of physical function designed to predict functional limitations and disability in elderly people? * What is the reliability of segmental segmental /seg·men·tal/ (seg-men´t'l) 1. pertaining to or forming a segment or a product of division, especially into serially arranged or nearly equal parts. 2. undergoing segmentation. mobility testing mobility testing Motion palpation Osteopathy A technique of classic osteopathy, in which the examiner evaluates each spinal segment for proper mobility in all planes of motion, and in relationship to above and below vertebrae. See Classic osteopathy, Osteopathy. in the cervical spine cervical spine Clinical anatomy The region of the vertebral column encompassing C1 through C7 ? * What are the reliability and validity of assessment of pronation pronation /pro·na·tion/ (-na´shun) the act of assuming the prone position, or the state of being prone. Applied to the hand, the act of turning the palm backward (posteriorly) or downward, performed by medial rotation of the forearm. of the foot in patients with knee pain? 1.3. What are the psychometric properties of classification systems ? * What is the reliability of the McKenzie classification system for the cervical spine? 1.4. How can data best be used for clinical decision making? * What information from the diagnosis/prognosis is used in patient/client management? * What factors beyond the diagnosis/ prognosis determine patient/client management? * When multiple tests and measures are used, how is the information weighted in determining a diagnosis? * What combination of examination data can be used to guide clinical decision making for patients with pain in the sacroiliac sacroiliac /sa·cro·il·i·ac/ (-il´e-ak) pertaining to the sacrum and ilium, or to their articulation. sac·ro·il·i·ac adj. region? * How does information from the systems review influence tests and measures chosen? * How does information from the history influence tests and measures chosen? * Do measures of postural alignment in people with spinal disorders influence clinical decision making, and, if so, how? * What factors influence the transfer of functional skills from the therapeutic environment to the community? 1.5. Are there combinations of measures of impairment and critical levels of function that would predict disability, and, if so, how can we determine them? * What are commonly performed physical functional tasks, and how do they differ across the life span? * Do measures of impairment and function predict a person's ability to work or return to work? * What are the variables, if any, that predict return of function in individuals following stroke? * What impairment-level and functional-level measures predict work capacities? * What information from measures can he used to predict physical function in community-dwelling elderly people? * What measurements of ambulation am·bu·late intr.v. am·bu·lat·ed, am·bu·lat·ing, am·bu·lates To walk from place to place; move about. [Latin ambul are useful for predicting patients' function? * Are there measures that can be used to predict independent function in an urban community, and, if so, what measures and at what thresholds? * Are there measures of ambulation that can be used to predict independent function in various communities, and, if so, at what thresholds? * Are there of elements of motor control mid cognitive function cognitive function Neurology Any mental process that involves symbolic operations–eg, perception, memory, creation of imagery, and thinking; CFs encompasses awareness and capacity for judgment that can be used to predict physical function in individuals with central nervous system dysfunction? 2. What is the usefulness of information derived from examination (history, review of systems, tests and measures) for prognosis? Examples of potential research questions include the following: 2.1. What measures are currently used for prognosis? * Are there measurements from the initial examination that predict future or concurrent mobility or disability, and, if so, how? * What factors are used by physical therapists to determine their recommendations of settings to which patients are discharged? * What tests and measures should be used to predict the physical therapy services patients will require upon discharge from inpatient care inpatient care Managed care Services delivered to a Pt who needs physician care for > 24 hrs in a hospital to achieve maximum function? 2.2 What are the natural histories of conditions for which physical therapists provide services? * What are the modifiable risk factors for cumulative trauma syndrome? * How are responses to exercise different in patients with neurological impairments? 2.3. What aye the relationships among pathology, impairment, functional limitation, and disability? * How do impairments affect disability in patients? * To what extent do variables such as pharmacology, psychosocial factors, and environmental factors influence the relationship among impairment, functional limitation, and disability in people receiving physical therapy interventions? * Are there critical levels and elements of motor control that must be present to permit household ambulation in individuals with brain dysfunction, and, if so, what are they? 2.4. What are the effects of demographic factors (eg, age, language, race, ethnicity, sex, social history, comorbidity, culture, family/caregiver resources) on the outcome of physical therapy interventions? * What are the characteristics of people who respond to various forms of therapy for low back pain? * Do patient knowledge, attitude, culture, understanding, mad expectations affect the outcome of physical therapy interventions, and, if so, how? * How can patient characteristics and environmental factors be used to predict adherence to home programs? * What are the factors that motivate patients to adhere to adhere to verb 1. follow, keep, maintain, respect, observe, be true, fulfil, obey, heed, keep to, abide by, be loyal, mind, be constant, be faithful 2. a plan of care? * Is there a relationship between a patient's satisfaction with care and adherence to his or her physical therapy care plan? * How does the physical environment in which the patient must function (eg, work requirements, mobility barriers) influence the effectiveness of treatment interventions? * How does the environment in which the patient must function influence the choice of physical therapy interventions? 3. What are the optimal characteristics of an intervention to achieve a desired effect or outcome (function, satisfaction, cost) for given diagnoses? Examples of potential research questions include the following: 3.1. What is the effectiveness of physical therapy intervention? * What is the effectiveness of segmental mobilization/ manipulation in reducing impairment and improving functional outcomes in patients with reduced segmental mobility? * Are manual techniques effective in the treatment of impairments and functional limitations? * What is the effect of exercise (duration, intensity, and type) on bone density? * Can physical therapy intervention for patients with spasticity spasticity /spas·tic·i·ty/ (spas-tis´i-te) the state of being spastic; see spastic (2). spas·tic·i·ty n. 1. A spastic state or condition. 2. Spastic paralysis. or rigidity improve function? 3.2. What is the optimal frequency intensity, and duration of an intervention to achieve a desired effect or outcome for a given diagnosis? * What interventions designed to change movement strategies can be used for patients with lumbar segmental instability, and what is the optimal pattern? * What interventions designed to decrease pain and paresthesias Paresthesias A prickly, tingling sensation. Mentioned in: Autoimmune Disorders can be used for patients with upper-extremity entrapment entrapment, in law, the instigation of a crime in the attempt to obtain cause for a criminal prosecution. Situations in which a government operative merely provides the occasion for the commission of a criminal act (e.g. syndromes, and what is the optimal pattern? * What is the effect of various intensities and durations of intervention on the rate and degree of functional recovery following anterior cruciate ligament injury anterior cruciate ligament injury Sports medicine An injury most common in sports characterized by abrupt changes of direction–eg, football, skiing, tennis, soccer Clinical Swelling, tenderness of knee Management ACL reconstruction via arthroscopy ? * Is there a relationship between weight-bearing exercises and the risk of fractures for people with bone demineralization demineralization /de·min·er·al·iza·tion/ (de-min?er-al-i-za´shun) excessive elimination of mineral or organic salts from tissues of the body. de·min·er·al·i·za·tion n. , and, if so, what is the relationship between exercise and risk? * What are the conditions of repetition and practice (whole/part, intermittent/continuous, attended/ unattended, number of trials per day) that optimize function in people with neuromuscular neuromuscular /neu·ro·mus·cu·lar/ (-mus´ku-ler) pertaining to nerves and muscles, or to the relationship between them. neu·ro·mus·cu·lar adj. 1. dysfunction? 3.3. Are there optimal time periods for interventions that influence pathology, impairment, functional limitation, and disability? * Are there optimal time periods for interventions that influence pathology, impairment, functional limitation, and disability in patients in whom multiple episodes of care are expected over the life span? * What is the optimal dose/response relationship for interventions (eg, aerobic and strengthening exercise, manual therapy, physical agents, traction/mechanical modalities, flexibility), given a specific category of a classification system for low back pain? * Are there changes to behavior and the environment that can be used to enhance function and prevent impairments, and, if so, what is the optimal pattern of use to achieve a therapeutic outcome? * Does immediate postoperative physical therapy intervention improve the rate of recovery of function in patients with impaired cardiovascular dysfunction, and, if so, how? * Does immediate postoperative physical therapy intervention affect the rate of recovery of function in patients following orthopedic surgery Orthopedic Surgery Definition Orthopedic (sometimes spelled orthopaedic) surgery is surgery performed by a medical specialist, such as an orthopedist or orthopedic surgeon, trained to deal with problems that develop in the bones, joints, and ligaments , and, if so, how? * Can interval training Interval training is broadly defined as repetitions of high-speed/intensity work followed by periods of rest or low activity. This training technique is often practiced by long distance runners (800 meters and above) although some sprinters are known to train using this be used to improve physiological and functional outcomes in frail elderly frail elderly, n.pl older persons (usually over the age of 75 years) who are afflicted with physical or mental disabilities that may interfere with the ability to independently perform activities of daily living. people? If yes, can the process of interval training be standardized with frail elderly people? * Are outcomes of treatment following peripheral nerve injury There is no single classification system that can describe all the many variations of nerve injury. Most systems attempt to correlate the degree of injury with symptoms, pathology and prognosis. using neuromuscular re-education improved by early assessment mad staged interventions? 3.4. What is the relative effectiveness of 2 or mare interventions far a particular patient diagnostic classification? * What is the relative effectiveness of immobilization Immobilization Definition Immobilization refers to the process of holding a joint or bone in place with a splint, cast, or brace. This is done to prevent an injured area from moving while it heals. versus mobilization in patients with nmsculoskeletal impairments on tissue healing and recovery of function? 3.5. What is the optimal combination of interventions to achieve desired patient outcomes? * Does the coordination of exercise and surgical interventions affect patient outcomes, and, if so, what is the optimal pattern of intervention? * Does the coordination of exercise and pharmacological interventions affect patient outcomes, and, if so, what is the optimal pattern of intervention? * What are the interactions between physical therapy interventions and pharmacological interventions? * What is the optimal resource schedule and utilization to achieve a desired effect or outcome for a given diagnosis? * What are the factors that affect cost for physical therapy services within specific diagnostic groups? 3.6. Are there factors that interact with physical therapy, interventions, and how do they interact to affect patient outcomes and clinical decision making? * Which, if any, devices mad equipment (assistive, adaptive, orthotic orthotic /or·thot·ic/ (or-thot´ik) serving to protect or to restore or improve function; pertaining to the use or application of an orthosis. or·thot·ic adj. Of or relating to orthotics. , protective, supportive, or prosthetic pros·thet·ic adj. 1. Serving as or relating to a prosthesis. 2. Of or relating to prosthetics. prosthetic serving as a substitute; pertaining to prostheses or to prosthetics. ) can be used by physical therapists to enhance function and prevent impairments, and what is the pattern of use to achieve a therapeutic outcome? * Do changes to behavior and the environment reduce the incidence of work-related cumulative trauma disorder cumulative trauma disorder Repetitive motion injury, repetitive stress disorder Occupational medicine Any of a group of conditions characterized by repeated stress on muscles, bones, tendons, nerves, which have psychologic and/or physical ramifications–eg, ? * Do physical therapists' knowledge, attitude, culture, understanding, and expectations affect the outcome of physical therapy interventions, and, if so, how? * Is there a difference in patient outcomes and costs dependent on whether services for a given diagnostic condition are provided by physical therapists or others? * How have changes resulting from health care reorganization affected the quality of physical therapy services, access to physical therapy services, patient satisfaction, staff productivity, staff longevity, and professional development? * Do payer source and policies influence satisfaction with access to physical therapy services in patients with acute conditions? * Do payer source and policies influence satisfaction with access to physical therapy services in patients with chronic conditions? * How does the requirement of referral before treatment affect whether patients have access to and are likely to utilize physical therapy services? 3.7. What factors predict supply, demand, and need for physical therapy services ? * What is the effect of the availability, cost, and payment source of physical therapy services on patient outcomes? * What are the factors that determine whether patients have access to and are likely to utilize physical therapy services? |
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