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Papers by Kerstin Palombaro

Physical therapist education programs strive to prepare their students for full-time clinical exp... more Physical therapist education programs strive to prepare their students for full-time clinical experiences in a variety of ways. Experiential and service learning in authentic contexts reportedly help students make connections between the classroom and the clinic. The purpose of this study was to explore the influences that service in a physical therapy pro bono clinic has on a first full-time clinical education experience. Methods: Participants were all third year doctoral physical therapy students at Widener University who were entering their first full-time clinical education experience. Sixteen participants kept journals throughout their first full-time clinical experience regarding the impact of their previous pro bono experience. Upon completion of the 10-week full-time clinical experience, the sixteen participants answered a Likert-scale survey to further delineate the influence of the pro bono experience, and fifteen of the participants participated in focus group discussions to further explore themes that emerged from the journal and survey data. Data from the focus group and journals were analyzed qualitatively. The responses from the surveys provided quantitative data. In addition, the researchers looked at the Clinical Instructors (CI) midterm comments on the APTA's Clinical Performance Instrument (APTA PT CPI WEB) to further corroborate or disconfirm the findings. Results: Triangulation of the data points revealed 9 categories of positive impact that the pro bono experience had on their first full-time clinical experience. The strongest three categories in order were client interaction, clinical instructor interaction, and professional communication. The next five categories were of relative equal strength and related to specifics areas of competency. They were competency in documentation, evaluation, intervention, clinical reasoning and cultural competency. A final overarching category was increased confidence. CI comments on the midterm CPI corroborated these findings. Participants also shared ways in which the pro bono experience could have better prepared them for their full-time clinical experience. Conclusions: Regular participation in a pro bono clinic throughout the didactic portion of the physical therapy curriculum contributed to student confidence and competence in their first full-time clinical experience. Future research should include interviews with the clinical instructors to further corroborate the student perceptions. The findings of this study also serve to inform how the pro bono clinical experience can be enhanced to further contribute positively to the students' first full-time clinical experiences.

Internet Journal of Allied Health Sciences and Practice, 2020

Purpose: Academic physical therapy programs strive to foster student readiness for full-time clin... more Purpose: Academic physical therapy programs strive to foster student readiness for full-time clinical education experiences in a variety of ways. This research looks at one program who has students participate in a student-run pro bono clinic for at least 60 hours prior to the first full-time clinic experience. The purpose of the study is to explore the influence that participation in this pro bono clinic has on a first full-time clinical education experience from the perspective of both the student and the clinical instructor (CI). Methods: Qualitative methodology was employed to gain the perspectives of 29 students and their respective CIs. Data collection included student journals and focus groups, and CI Likert-scale rankings and open-ended questions upon midterm calls. Data points were triangulated through iterative data analysis. Results: CIs rated students high in the eight categories that were triangulated to student data. The themes that were strongest among both students a...

Journal of community engagement and higher education, 2017

International service-learning (ISL) programs in physical and occupational therapy programs are i... more International service-learning (ISL) programs in physical and occupational therapy programs are increasing in number. This paper describes a needs assessment and initial program evaluation conducted for a physical therapy ISL program at an orphanage in China. Chinese orphanage staff and Widener University physical therapy students were surveyed. Chinese staff expressed satisfaction with the training and provided suggestions for programming needs. Stu-dents identified areas for further education of orphanage staff and suggestions for future pro-gram design.

Internet Journal of Allied Health Sciences and Practice, 2020

Purpose: The offering of pro bono services has been a historical practice in a number of professi... more Purpose: The offering of pro bono services has been a historical practice in a number of professions including law and medicine. Medical literature suggests pro bono services provide a vital safety net for individuals who are underinsured or uninsured. Medical students commonly participate in pro bono services, however, little is known about doctor of physical therapy (DPT) student involvement. The purpose of this study was to conduct a survey of physical therapy (PT) programs accredited or in candidacy in the United States to determine the prevalence and characteristics of pro bono services involving DPT students. Method: A 30-item electronic survey was sent to 101 individuals representing accredited or in candidacy PT programs thought to be involved with students in the delivery of PT pro bono services. Data were analyzed using SPSS. Frequency counts and percentages were used to describe prevalence and characteristics of current pro bono services. Results: The response rate was 71...

Internet Journal of Allied Health Sciences and Practice, 2017

Purpose: Physical therapist education programs strive to prepare their students for full-time cli... more Purpose: Physical therapist education programs strive to prepare their students for full-time clinical experiences in a variety of ways. Experiential and service learning in authentic contexts reportedly help students make connections between the classroom and the clinic. The purpose of this study was to explore the influences that service in a physical therapy pro bono clinic has on a first full-time clinical education experience. Methods: Participants were all third year doctoral physical therapy students at Widener University who were entering their first full-time clinical education experience. Sixteen participants kept journals throughout their first full-time clinical experience regarding the impact of their previous pro bono experience. Upon completion of the 10-week full-time clinical experience, the sixteen participants answered a Likert-scale survey to further delineate the influence of the pro bono experience, and fifteen of the participants participated in focus group di...

Journal of Physical Therapy Education, 2016

Methods. The IAPCC-SV© was administered to 79 students in Fall 2014, and 52 students completed a ... more Methods. The IAPCC-SV© was administered to 79 students in Fall 2014, and 52 students completed a retest 1 week later. Test-retest reliability and MDC for the IAPCC-SV© scale and subscales were calculated. Results. For the combined DPT and ATHP groups, the MDC 95 of the entire tool was 4.1, internal consistency (Cronbach's alpha) was .861, and overall testretest reliability was .938. The MDC 95 of the individual subscales are as follows: cultural awareness = 1.34, knowledge = 2.02, skill = 1.52, encounters = 1.61, and desire = 1.17. The range of subscale internal consistency (Cronbach's alpha) was .431 to .798, while the range of test-retest reliabilities was .766 to .936. Discussion and Conclusion. The current results provide MDC values of the IAPCC-SV© in 2 additional student groups. The MDC of the cultural knowledge and cultural desire construct subscales can be used to interpret changes in their respective domains of the IAPCC-SV© after an educational intervention.

Journal of Geriatric Physical Therapy, 2019

Background and Purpose: Sit-to-stand tests measure a clinically relevant function and are widely ... more Background and Purpose: Sit-to-stand tests measure a clinically relevant function and are widely used in older adult populations. The modified 30-second sit-to-stand test (m30STS) overcomes the floor effect of other sit-to-stand tests observed in physically challenged older adults. The purpose of this study was to examine interrater and test-retest intrarater reliability for the m30STS for older adults. In addition, convergent validity of the m30STS, as well as responsiveness to change, was examined in older adults undergoing rehabilitation. Methods: In phase I, 7 older adult participants were filmed performing the m30STS. The m30STS was standardized to allow hand support during the rise to and descent from standing but required participants to let go of the armrests with each stand. Ten physical therapists and physical therapist assistants independently scored the filmed m30STS twice, with 21 days separating the scoring sessions. In phase II, 33 older adults with comorbidities admitted to physical therapy services at a skilled nursing facility were administered the m30STS, Berg Balance Scale, handheld dynamometry of knee extensors, and the modified Barthel Index at initial examination and discharge. Results: In phase I, the m30STS was found to be reliable. Interrater reliability using absolute agreement was calculated as intraclass correlation coefficient (ICC)2,1 = 0.737 (P ≤ .001). Test-retest intrarater reliability using absolute agreement was calculated as ICC2,k = 0.987 (P ≤ .001). In phase II, concurrent validity was established for the m30STS for the initial (Spearman ρ = 0.737, P = .01) and discharge (Spearman ρ = 0.727, P = .01) Berg Balance Scale as well as total scores of the modified Barthel Index (initial total score Spearman ρ = 0.711, P = .01; discharge total score Spearman ρ = 0.824, P = .01). The initial m30STS predicted 31.5% of the variability in the discharge Berg Balance Scale. The m30STS did not demonstrate significant correlation with body weight–adjusted strength measures of knee extensors measured by handheld dynamometry. The minimal detectable change (MDC90) was calculated to be 0.70, meaning that an increase of 1 additional repetition in the m30STS is a change beyond error. Conclusion: The m30STS is a reliable, feasible tool for use in a general geriatric population with a lower level of function. The m30STS demonstrated concurrent validity with the Berg Balance Scale and modified Barthel Index but not with knee extensor strength to body weight ratio. One repetition of the m30STS was established as the MDC90 as change beyond error.

Journal of Physical Therapy Education, 2019

Introduction. Health science graduate students take high stakes examinations and experience stres... more Introduction. Health science graduate students take high stakes examinations and experience stress and burnout, which can negatively influence performance in clinical courses. e intent of this study was to pilot a curriculum in mindful practice for graduate health science students under high levels of perceived stress. e purpose of this study was to determine the effectiveness of an abbreviated mindfulness workshop to determine if it would provide lasting benefit for students during clinical experiences 9 months later. Methods. Twenty-three graduate students across 4 health professions participated in a 6-week workshop for stress management in March 2017. Students were executed to practice mindfulness activities for 15 minutes daily over the 6 weeks. Weekly meetings included meditation, mindful movement, and small group discussion. A mixed methods approach incorporated pre-and postworkshop measures exploring students' levels of worry, perceived stress, feelings of isolation, self-judgment, selfkindness, overidentification, and mindfulness. Additional survey data were collected 9 months later to determine if the tools learned in the workshop influenced clinical performance. Qualitative comments were coded using generic qualitative analysis, and member checking confirmed themes. Results. Overall, students demonstrated improvements in all measures of stress over the 6-week workshop. Additionally, they reported positive influences on clinical performance in the affective and cognitive domains 9 months later. Four main themes were extracted from the data. ese were I Have Tools; ink, Pause, Allow; Silence the Critic; and, I Am Not Alone. Overall, the participants experienced significant improvements in mindfulness scores and self-compassion, and showed improvements in perceived stress and worry (Cognitive-Affective Mindfulness Scale-revised). Discussion and Conclusion. Altogether, these data suggest that (1) graduate students can learn to manage worry, feelings of isolation, and self-judgment using tools and strategies from mindful practices; (2) students who practice mindfulness in a 6week workshop report lasting effects during clinical performance 9 months later; and (3) students benefit from a community of peers and a shared space to share their thoughts and feelings as emerging health professionals. Suggestions are made for integrating mindful practices into graduate health science education.

Cardiopulmonary Physical Therapy Journal, 2011

Physical Therapy, 2016

Background and Purpose. Older subjects after hip fracture walk more slowly than age-matched peers... more Background and Purpose. Older subjects after hip fracture walk more slowly than age-matched peers. The extent to which they walk more slowly is difficult to define because the standard error of the measure (SEM), sensitivity to change, and clinically important change have not been reported for gait speed. The purposes of this study were to quantify the SEM for habitual and fast gait speeds among older subjects after hip fracture, to define the minimal detectable change (MDC), and to estimate the minimal clinically important difference (MCID) for habitual gait speed. Subjects. A sample of 92 subjects after hip fracture was drawn from 3 studies that collected gait speed data. Methods. An estimate of the MDC was determined by use of the SEM. The MCID was determined from expert opinion and from a receiver operating characteristic (ROC) curve. Results. The SEM and the MDC were 0.08 m/s and 0.10 m/s for habitual speed and fast speed, respectively. Both methods of MCID estimation identifie...

Physical Therapy, 2005

Background and Purpose. Most patients with hip fracture do not return to prefracture functional s... more Background and Purpose. Most patients with hip fracture do not return to prefracture functional status 1 year after surgery. The literature describing interventions, however, does not use classic overload and specificity principles. The purpose of this case report is to describe the use of resistance training to improve functional outcomes in a patient following hip fracture. Case Description. The patient was a 68-year-old woman who had a comminuted intertrochanteric fracture of the left hip 3 months previously. She used a cane for ambulation, and her walking was limited. The patient received 16 sessions of lower-extremity strengthening exercises, aerobic training on a stationary bicycle, functional training supervised by a physical therapist, and a home stretching program. Outcome. The patient's isometric muscle force for involved hip extension, hip abduction, and knee extension improved by 86%, 138%, and 33%, respectively; walking endurance increased by 22.5%; balance improved...

Physical Therapy, 2005

Background and Purpose. The majority of patients after a hip fracture do not return to prefractur... more Background and Purpose. The majority of patients after a hip fracture do not return to prefracture functional status. Depression has been shown to affect recovery. Although exercise can reduce impairments, access issues limit elderly people from participating in facility-based programs. The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate- or high-intensity exercise. A secondary purpose was to explore the relationship of depression and physical recovery. Subjects. Thirty-three elderly people (24 women, 9 men; X̄=78.6 years of age, SD=6.8, range=64-89) who had completed a regimen of physical therapy following hip fracture participated in the study. Subjects were randomly assigned to a resistance training group, an aerobic training group, or a control group. Methods. Subjects were tested before and upon completion of the exercise trial. Isometric lower-extremity force, 6-minute-walk distance, free gait speed, mental stat...

Journal of the Scholarship of Teaching and Learning, 2017

Background and Purpose. Grand Rounds is a teaching methodology that has existed in various forms ... more Background and Purpose. Grand Rounds is a teaching methodology that has existed in various forms in medical education for centuries. When a student-run pro bono clinic identified a growing challenge of providing continuity of care for clients and a lack of preparedness in students, they implemented a Grand Rounds model of case presentation within the curriculum. The purpose of this paper is to describe the implementation and assessment of Grand Rounds as it attempts to improve both the continuity of care for the clients and the learning experience for the students involved in a student-run pro bono clinic.Case Description and Evaluation. The Student Board divided the student physical therapists and the clients into three teams. Each team of students would meet every three weeks to discuss the clients on their caseload. More advanced students helped to mentor the more novice students and a faculty member would facilitate the discussions. Outcomes. After eight months of implementati...

Journal of Geriatric Physical Therapy, 2005

Background and purpose Osteoporosis, a common disease in postmenopausal women and the elderly, is... more Background and purpose Osteoporosis, a common disease in postmenopausal women and the elderly, is associated with decreases in bone mineral density (BMD) and fractures. As weight-bearing activity such as walking has the potential to maintain or increase BMD, I sought in this meta-analysis to mathematically consolidate research on the effects of walking interventions on BMD. Methods: A literature search for studies examining the effect of walking on BMD in postmenopausal women and men and women aged 50 years and older was conducted. Search strategies included online literature searches, hand-searches of journals, and examination of the reference lists of articles selected for inclusion. Effect sizes were calculated for each article selected for inclusion and a meta-analysis was conducted for these articles. Results: Ten articles met the inclusion criteria for the meta-analysis. Walking had a significant (P < .03) positive effect (.32) on lumbar BMD but not on the femur or the calcaneus. Discussion and Conclusion: The results of this meta-analysis do not suggest that walking interventions alone will limit demineralization at all skeletal sites. Perhaps other forms of exercise in addition to walking should be incorporated into training regimens for patients at risk for osteoporosis.

Current pain and headache reports, 2014

Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily u... more Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily used with patients that have pain of myofascial origin. This review provides background about dry needling, myofascial pain, and craniofacial pain. We summarize the evidence regarding the effectiveness of dry needling. For patients with upper quarter myofascial pain, a 2013 systematic review and meta-analysis of 12 randomized controlled studies reported that dry needling is effective in reducing pain (especially immediately after treatment) in patients with upper quarter pain. There have been fewer studies of patients with craniofacial pain and myofascial pain in other regions, but most of these studies report findings to suggest the dry needling may be helpful in reducing pain and improving other pain related variables such as the pain pressure threshold. More rigorous randomized controlled trials are clearly needed to more fully elucidate the effectiveness of dry needling.

Journal of geriatric physical therapy (2001)

The model provided by the World Health Organization's International Classification of Functio... more The model provided by the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) was created to describe, classify, and measure function in both health care practice and research. This model has not been applied to management of many physical therapy cases, limiting its implementation conceptually into practice as a whole. The purpose of this case report is to illustrate the use of the ICF model in the evidence-based management of posterior canal benign paroxysmal positional vertigo. One patient with acute posterior canal canalithiasis benign paroxysmal positional vertigo was treated using the evidence-based clinical practice guideline for the diagnosis as well as the ICF framework. Repositioning maneuvers and education were provided to ameliorate the relevant body structure and function impairments, activity limitations, and contextual factors related to the patient's overall functioning and disability. The patient demonstrated...

Journal of Women's Health Physical Therapy, 2008

... Literature Review. Osteopenia and Sarcopenia: Factors Related to Physical Frailty in Women. P... more ... Literature Review. Osteopenia and Sarcopenia: Factors Related to Physical Frailty in Women. Palombaro, Kerstin M. PT, PhD1; Hack, Laurita M. DPT, MBA, PhD, FAPTA2; Mangione, Kathleen Kline PT, PhD, GCS3; Barr, Ann E. DPT, PhD4; Newton, Roberta A. PT, PhD2. ...

Physical Therapy, 2007

Background and PurposeThe majority of older people who survive a hip fracture have residual mobil... more Background and PurposeThe majority of older people who survive a hip fracture have residual mobility disabilities. Any attempt to systematically reduce mobility disabilities after hip fracture, however, requires knowledge of the adequacy of current management practices. Therefore, the purpose of this study was to begin to understand the nature of physical therapy home care management by describing “usual care” for people after hip fracture.Subjects and MethodsIn 2003 and 2004, a national survey was conducted of all members of the American Physical Therapy Association who identified home care as their primary practice setting (n=3,130). “Usual care” was operationally defined as when more than 50% of respondents reported that they “always” or “often” use a specific intervention.ResultsSurvey questionnaires (1,029) were returned with a response rate of 32.9%. Functional training activities, including bed mobility, transfer and gait training, balance training, safety training, and patie...

Physical Therapy, 2011

Background and Purpose. The Chester Community Physical Therapy Clinic (clinic) is a student-led p... more Background and Purpose. The Chester Community Physical Therapy Clinic (clinic) is a student-led pro bono clinic that provides physical therapy services to uninsured and underinsured community members. The purposes of this administrative case report are to describe the creation and implementation of a student-led pro bono clinic model designed to meet student and community needs and to consider its potential for sustainability. Case Description. Students and faculty created an organizational model with a Student Board at the center of clinic leadership. A Faculty Board provides oversight to the Student Board. State-licensed faculty and alumni provide the direct supervision of the treating student physical therapists. Evaluation of our clinic model was performed using strategies for the creation of sustainable community engagement initiatives. Outcomes. This model of a student-led pro bono clinic has elements of all 8 steps to sustainable community engagement. The model of a student-led pro bono clinic is feasible and sustainable. Discussion. A student-led pro bono clinic serving the physical therapy needs of the uninsured and underinsured residents in an urban community presents an innovative educational and leadership development opportunity for students and alumni as well as partnership opportunities with the community.

Physical Therapy, 2013

Background The physical therapy profession has called for the provision of pro bono services. Lit... more Background The physical therapy profession has called for the provision of pro bono services. Little is known about the impact on students involved in sustainable pro bono leadership. One physical therapy program established a pro bono physical therapy clinic under the direct leadership of a board of students. Objective The purpose of this study was to describe the experiences of the inaugural members of the Chester Community Physical Therapy Clinic Student Board in creating and launching the student-led pro bono physical therapy clinic. Methods A purposive sample of the 18 members participated in semistructured interviews. Content analysis was conducted using a commercially available software program. Trustworthiness was enhanced with credibility, transferability, and confirmability. Results The emergent categories were: (1) leadership skill development, (2) competency in hands-on clinical and administrative skills, and (3) commitment to both the community and the clinic. Pride eme...

Physical therapist education programs strive to prepare their students for full-time clinical exp... more Physical therapist education programs strive to prepare their students for full-time clinical experiences in a variety of ways. Experiential and service learning in authentic contexts reportedly help students make connections between the classroom and the clinic. The purpose of this study was to explore the influences that service in a physical therapy pro bono clinic has on a first full-time clinical education experience. Methods: Participants were all third year doctoral physical therapy students at Widener University who were entering their first full-time clinical education experience. Sixteen participants kept journals throughout their first full-time clinical experience regarding the impact of their previous pro bono experience. Upon completion of the 10-week full-time clinical experience, the sixteen participants answered a Likert-scale survey to further delineate the influence of the pro bono experience, and fifteen of the participants participated in focus group discussions to further explore themes that emerged from the journal and survey data. Data from the focus group and journals were analyzed qualitatively. The responses from the surveys provided quantitative data. In addition, the researchers looked at the Clinical Instructors (CI) midterm comments on the APTA's Clinical Performance Instrument (APTA PT CPI WEB) to further corroborate or disconfirm the findings. Results: Triangulation of the data points revealed 9 categories of positive impact that the pro bono experience had on their first full-time clinical experience. The strongest three categories in order were client interaction, clinical instructor interaction, and professional communication. The next five categories were of relative equal strength and related to specifics areas of competency. They were competency in documentation, evaluation, intervention, clinical reasoning and cultural competency. A final overarching category was increased confidence. CI comments on the midterm CPI corroborated these findings. Participants also shared ways in which the pro bono experience could have better prepared them for their full-time clinical experience. Conclusions: Regular participation in a pro bono clinic throughout the didactic portion of the physical therapy curriculum contributed to student confidence and competence in their first full-time clinical experience. Future research should include interviews with the clinical instructors to further corroborate the student perceptions. The findings of this study also serve to inform how the pro bono clinical experience can be enhanced to further contribute positively to the students' first full-time clinical experiences.

Internet Journal of Allied Health Sciences and Practice, 2020

Purpose: Academic physical therapy programs strive to foster student readiness for full-time clin... more Purpose: Academic physical therapy programs strive to foster student readiness for full-time clinical education experiences in a variety of ways. This research looks at one program who has students participate in a student-run pro bono clinic for at least 60 hours prior to the first full-time clinic experience. The purpose of the study is to explore the influence that participation in this pro bono clinic has on a first full-time clinical education experience from the perspective of both the student and the clinical instructor (CI). Methods: Qualitative methodology was employed to gain the perspectives of 29 students and their respective CIs. Data collection included student journals and focus groups, and CI Likert-scale rankings and open-ended questions upon midterm calls. Data points were triangulated through iterative data analysis. Results: CIs rated students high in the eight categories that were triangulated to student data. The themes that were strongest among both students a...

Journal of community engagement and higher education, 2017

International service-learning (ISL) programs in physical and occupational therapy programs are i... more International service-learning (ISL) programs in physical and occupational therapy programs are increasing in number. This paper describes a needs assessment and initial program evaluation conducted for a physical therapy ISL program at an orphanage in China. Chinese orphanage staff and Widener University physical therapy students were surveyed. Chinese staff expressed satisfaction with the training and provided suggestions for programming needs. Stu-dents identified areas for further education of orphanage staff and suggestions for future pro-gram design.

Internet Journal of Allied Health Sciences and Practice, 2020

Purpose: The offering of pro bono services has been a historical practice in a number of professi... more Purpose: The offering of pro bono services has been a historical practice in a number of professions including law and medicine. Medical literature suggests pro bono services provide a vital safety net for individuals who are underinsured or uninsured. Medical students commonly participate in pro bono services, however, little is known about doctor of physical therapy (DPT) student involvement. The purpose of this study was to conduct a survey of physical therapy (PT) programs accredited or in candidacy in the United States to determine the prevalence and characteristics of pro bono services involving DPT students. Method: A 30-item electronic survey was sent to 101 individuals representing accredited or in candidacy PT programs thought to be involved with students in the delivery of PT pro bono services. Data were analyzed using SPSS. Frequency counts and percentages were used to describe prevalence and characteristics of current pro bono services. Results: The response rate was 71...

Internet Journal of Allied Health Sciences and Practice, 2017

Purpose: Physical therapist education programs strive to prepare their students for full-time cli... more Purpose: Physical therapist education programs strive to prepare their students for full-time clinical experiences in a variety of ways. Experiential and service learning in authentic contexts reportedly help students make connections between the classroom and the clinic. The purpose of this study was to explore the influences that service in a physical therapy pro bono clinic has on a first full-time clinical education experience. Methods: Participants were all third year doctoral physical therapy students at Widener University who were entering their first full-time clinical education experience. Sixteen participants kept journals throughout their first full-time clinical experience regarding the impact of their previous pro bono experience. Upon completion of the 10-week full-time clinical experience, the sixteen participants answered a Likert-scale survey to further delineate the influence of the pro bono experience, and fifteen of the participants participated in focus group di...

Journal of Physical Therapy Education, 2016

Methods. The IAPCC-SV© was administered to 79 students in Fall 2014, and 52 students completed a ... more Methods. The IAPCC-SV© was administered to 79 students in Fall 2014, and 52 students completed a retest 1 week later. Test-retest reliability and MDC for the IAPCC-SV© scale and subscales were calculated. Results. For the combined DPT and ATHP groups, the MDC 95 of the entire tool was 4.1, internal consistency (Cronbach's alpha) was .861, and overall testretest reliability was .938. The MDC 95 of the individual subscales are as follows: cultural awareness = 1.34, knowledge = 2.02, skill = 1.52, encounters = 1.61, and desire = 1.17. The range of subscale internal consistency (Cronbach's alpha) was .431 to .798, while the range of test-retest reliabilities was .766 to .936. Discussion and Conclusion. The current results provide MDC values of the IAPCC-SV© in 2 additional student groups. The MDC of the cultural knowledge and cultural desire construct subscales can be used to interpret changes in their respective domains of the IAPCC-SV© after an educational intervention.

Journal of Geriatric Physical Therapy, 2019

Background and Purpose: Sit-to-stand tests measure a clinically relevant function and are widely ... more Background and Purpose: Sit-to-stand tests measure a clinically relevant function and are widely used in older adult populations. The modified 30-second sit-to-stand test (m30STS) overcomes the floor effect of other sit-to-stand tests observed in physically challenged older adults. The purpose of this study was to examine interrater and test-retest intrarater reliability for the m30STS for older adults. In addition, convergent validity of the m30STS, as well as responsiveness to change, was examined in older adults undergoing rehabilitation. Methods: In phase I, 7 older adult participants were filmed performing the m30STS. The m30STS was standardized to allow hand support during the rise to and descent from standing but required participants to let go of the armrests with each stand. Ten physical therapists and physical therapist assistants independently scored the filmed m30STS twice, with 21 days separating the scoring sessions. In phase II, 33 older adults with comorbidities admitted to physical therapy services at a skilled nursing facility were administered the m30STS, Berg Balance Scale, handheld dynamometry of knee extensors, and the modified Barthel Index at initial examination and discharge. Results: In phase I, the m30STS was found to be reliable. Interrater reliability using absolute agreement was calculated as intraclass correlation coefficient (ICC)2,1 = 0.737 (P ≤ .001). Test-retest intrarater reliability using absolute agreement was calculated as ICC2,k = 0.987 (P ≤ .001). In phase II, concurrent validity was established for the m30STS for the initial (Spearman ρ = 0.737, P = .01) and discharge (Spearman ρ = 0.727, P = .01) Berg Balance Scale as well as total scores of the modified Barthel Index (initial total score Spearman ρ = 0.711, P = .01; discharge total score Spearman ρ = 0.824, P = .01). The initial m30STS predicted 31.5% of the variability in the discharge Berg Balance Scale. The m30STS did not demonstrate significant correlation with body weight–adjusted strength measures of knee extensors measured by handheld dynamometry. The minimal detectable change (MDC90) was calculated to be 0.70, meaning that an increase of 1 additional repetition in the m30STS is a change beyond error. Conclusion: The m30STS is a reliable, feasible tool for use in a general geriatric population with a lower level of function. The m30STS demonstrated concurrent validity with the Berg Balance Scale and modified Barthel Index but not with knee extensor strength to body weight ratio. One repetition of the m30STS was established as the MDC90 as change beyond error.

Journal of Physical Therapy Education, 2019

Introduction. Health science graduate students take high stakes examinations and experience stres... more Introduction. Health science graduate students take high stakes examinations and experience stress and burnout, which can negatively influence performance in clinical courses. e intent of this study was to pilot a curriculum in mindful practice for graduate health science students under high levels of perceived stress. e purpose of this study was to determine the effectiveness of an abbreviated mindfulness workshop to determine if it would provide lasting benefit for students during clinical experiences 9 months later. Methods. Twenty-three graduate students across 4 health professions participated in a 6-week workshop for stress management in March 2017. Students were executed to practice mindfulness activities for 15 minutes daily over the 6 weeks. Weekly meetings included meditation, mindful movement, and small group discussion. A mixed methods approach incorporated pre-and postworkshop measures exploring students' levels of worry, perceived stress, feelings of isolation, self-judgment, selfkindness, overidentification, and mindfulness. Additional survey data were collected 9 months later to determine if the tools learned in the workshop influenced clinical performance. Qualitative comments were coded using generic qualitative analysis, and member checking confirmed themes. Results. Overall, students demonstrated improvements in all measures of stress over the 6-week workshop. Additionally, they reported positive influences on clinical performance in the affective and cognitive domains 9 months later. Four main themes were extracted from the data. ese were I Have Tools; ink, Pause, Allow; Silence the Critic; and, I Am Not Alone. Overall, the participants experienced significant improvements in mindfulness scores and self-compassion, and showed improvements in perceived stress and worry (Cognitive-Affective Mindfulness Scale-revised). Discussion and Conclusion. Altogether, these data suggest that (1) graduate students can learn to manage worry, feelings of isolation, and self-judgment using tools and strategies from mindful practices; (2) students who practice mindfulness in a 6week workshop report lasting effects during clinical performance 9 months later; and (3) students benefit from a community of peers and a shared space to share their thoughts and feelings as emerging health professionals. Suggestions are made for integrating mindful practices into graduate health science education.

Cardiopulmonary Physical Therapy Journal, 2011

Physical Therapy, 2016

Background and Purpose. Older subjects after hip fracture walk more slowly than age-matched peers... more Background and Purpose. Older subjects after hip fracture walk more slowly than age-matched peers. The extent to which they walk more slowly is difficult to define because the standard error of the measure (SEM), sensitivity to change, and clinically important change have not been reported for gait speed. The purposes of this study were to quantify the SEM for habitual and fast gait speeds among older subjects after hip fracture, to define the minimal detectable change (MDC), and to estimate the minimal clinically important difference (MCID) for habitual gait speed. Subjects. A sample of 92 subjects after hip fracture was drawn from 3 studies that collected gait speed data. Methods. An estimate of the MDC was determined by use of the SEM. The MCID was determined from expert opinion and from a receiver operating characteristic (ROC) curve. Results. The SEM and the MDC were 0.08 m/s and 0.10 m/s for habitual speed and fast speed, respectively. Both methods of MCID estimation identifie...

Physical Therapy, 2005

Background and Purpose. Most patients with hip fracture do not return to prefracture functional s... more Background and Purpose. Most patients with hip fracture do not return to prefracture functional status 1 year after surgery. The literature describing interventions, however, does not use classic overload and specificity principles. The purpose of this case report is to describe the use of resistance training to improve functional outcomes in a patient following hip fracture. Case Description. The patient was a 68-year-old woman who had a comminuted intertrochanteric fracture of the left hip 3 months previously. She used a cane for ambulation, and her walking was limited. The patient received 16 sessions of lower-extremity strengthening exercises, aerobic training on a stationary bicycle, functional training supervised by a physical therapist, and a home stretching program. Outcome. The patient's isometric muscle force for involved hip extension, hip abduction, and knee extension improved by 86%, 138%, and 33%, respectively; walking endurance increased by 22.5%; balance improved...

Physical Therapy, 2005

Background and Purpose. The majority of patients after a hip fracture do not return to prefractur... more Background and Purpose. The majority of patients after a hip fracture do not return to prefracture functional status. Depression has been shown to affect recovery. Although exercise can reduce impairments, access issues limit elderly people from participating in facility-based programs. The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate- or high-intensity exercise. A secondary purpose was to explore the relationship of depression and physical recovery. Subjects. Thirty-three elderly people (24 women, 9 men; X̄=78.6 years of age, SD=6.8, range=64-89) who had completed a regimen of physical therapy following hip fracture participated in the study. Subjects were randomly assigned to a resistance training group, an aerobic training group, or a control group. Methods. Subjects were tested before and upon completion of the exercise trial. Isometric lower-extremity force, 6-minute-walk distance, free gait speed, mental stat...

Journal of the Scholarship of Teaching and Learning, 2017

Background and Purpose. Grand Rounds is a teaching methodology that has existed in various forms ... more Background and Purpose. Grand Rounds is a teaching methodology that has existed in various forms in medical education for centuries. When a student-run pro bono clinic identified a growing challenge of providing continuity of care for clients and a lack of preparedness in students, they implemented a Grand Rounds model of case presentation within the curriculum. The purpose of this paper is to describe the implementation and assessment of Grand Rounds as it attempts to improve both the continuity of care for the clients and the learning experience for the students involved in a student-run pro bono clinic.Case Description and Evaluation. The Student Board divided the student physical therapists and the clients into three teams. Each team of students would meet every three weeks to discuss the clients on their caseload. More advanced students helped to mentor the more novice students and a faculty member would facilitate the discussions. Outcomes. After eight months of implementati...

Journal of Geriatric Physical Therapy, 2005

Background and purpose Osteoporosis, a common disease in postmenopausal women and the elderly, is... more Background and purpose Osteoporosis, a common disease in postmenopausal women and the elderly, is associated with decreases in bone mineral density (BMD) and fractures. As weight-bearing activity such as walking has the potential to maintain or increase BMD, I sought in this meta-analysis to mathematically consolidate research on the effects of walking interventions on BMD. Methods: A literature search for studies examining the effect of walking on BMD in postmenopausal women and men and women aged 50 years and older was conducted. Search strategies included online literature searches, hand-searches of journals, and examination of the reference lists of articles selected for inclusion. Effect sizes were calculated for each article selected for inclusion and a meta-analysis was conducted for these articles. Results: Ten articles met the inclusion criteria for the meta-analysis. Walking had a significant (P < .03) positive effect (.32) on lumbar BMD but not on the femur or the calcaneus. Discussion and Conclusion: The results of this meta-analysis do not suggest that walking interventions alone will limit demineralization at all skeletal sites. Perhaps other forms of exercise in addition to walking should be incorporated into training regimens for patients at risk for osteoporosis.

Current pain and headache reports, 2014

Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily u... more Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily used with patients that have pain of myofascial origin. This review provides background about dry needling, myofascial pain, and craniofacial pain. We summarize the evidence regarding the effectiveness of dry needling. For patients with upper quarter myofascial pain, a 2013 systematic review and meta-analysis of 12 randomized controlled studies reported that dry needling is effective in reducing pain (especially immediately after treatment) in patients with upper quarter pain. There have been fewer studies of patients with craniofacial pain and myofascial pain in other regions, but most of these studies report findings to suggest the dry needling may be helpful in reducing pain and improving other pain related variables such as the pain pressure threshold. More rigorous randomized controlled trials are clearly needed to more fully elucidate the effectiveness of dry needling.

Journal of geriatric physical therapy (2001)

The model provided by the World Health Organization's International Classification of Functio... more The model provided by the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) was created to describe, classify, and measure function in both health care practice and research. This model has not been applied to management of many physical therapy cases, limiting its implementation conceptually into practice as a whole. The purpose of this case report is to illustrate the use of the ICF model in the evidence-based management of posterior canal benign paroxysmal positional vertigo. One patient with acute posterior canal canalithiasis benign paroxysmal positional vertigo was treated using the evidence-based clinical practice guideline for the diagnosis as well as the ICF framework. Repositioning maneuvers and education were provided to ameliorate the relevant body structure and function impairments, activity limitations, and contextual factors related to the patient's overall functioning and disability. The patient demonstrated...

Journal of Women's Health Physical Therapy, 2008

... Literature Review. Osteopenia and Sarcopenia: Factors Related to Physical Frailty in Women. P... more ... Literature Review. Osteopenia and Sarcopenia: Factors Related to Physical Frailty in Women. Palombaro, Kerstin M. PT, PhD1; Hack, Laurita M. DPT, MBA, PhD, FAPTA2; Mangione, Kathleen Kline PT, PhD, GCS3; Barr, Ann E. DPT, PhD4; Newton, Roberta A. PT, PhD2. ...

Physical Therapy, 2007

Background and PurposeThe majority of older people who survive a hip fracture have residual mobil... more Background and PurposeThe majority of older people who survive a hip fracture have residual mobility disabilities. Any attempt to systematically reduce mobility disabilities after hip fracture, however, requires knowledge of the adequacy of current management practices. Therefore, the purpose of this study was to begin to understand the nature of physical therapy home care management by describing “usual care” for people after hip fracture.Subjects and MethodsIn 2003 and 2004, a national survey was conducted of all members of the American Physical Therapy Association who identified home care as their primary practice setting (n=3,130). “Usual care” was operationally defined as when more than 50% of respondents reported that they “always” or “often” use a specific intervention.ResultsSurvey questionnaires (1,029) were returned with a response rate of 32.9%. Functional training activities, including bed mobility, transfer and gait training, balance training, safety training, and patie...

Physical Therapy, 2011

Background and Purpose. The Chester Community Physical Therapy Clinic (clinic) is a student-led p... more Background and Purpose. The Chester Community Physical Therapy Clinic (clinic) is a student-led pro bono clinic that provides physical therapy services to uninsured and underinsured community members. The purposes of this administrative case report are to describe the creation and implementation of a student-led pro bono clinic model designed to meet student and community needs and to consider its potential for sustainability. Case Description. Students and faculty created an organizational model with a Student Board at the center of clinic leadership. A Faculty Board provides oversight to the Student Board. State-licensed faculty and alumni provide the direct supervision of the treating student physical therapists. Evaluation of our clinic model was performed using strategies for the creation of sustainable community engagement initiatives. Outcomes. This model of a student-led pro bono clinic has elements of all 8 steps to sustainable community engagement. The model of a student-led pro bono clinic is feasible and sustainable. Discussion. A student-led pro bono clinic serving the physical therapy needs of the uninsured and underinsured residents in an urban community presents an innovative educational and leadership development opportunity for students and alumni as well as partnership opportunities with the community.

Physical Therapy, 2013

Background The physical therapy profession has called for the provision of pro bono services. Lit... more Background The physical therapy profession has called for the provision of pro bono services. Little is known about the impact on students involved in sustainable pro bono leadership. One physical therapy program established a pro bono physical therapy clinic under the direct leadership of a board of students. Objective The purpose of this study was to describe the experiences of the inaugural members of the Chester Community Physical Therapy Clinic Student Board in creating and launching the student-led pro bono physical therapy clinic. Methods A purposive sample of the 18 members participated in semistructured interviews. Content analysis was conducted using a commercially available software program. Trustworthiness was enhanced with credibility, transferability, and confirmability. Results The emergent categories were: (1) leadership skill development, (2) competency in hands-on clinical and administrative skills, and (3) commitment to both the community and the clinic. Pride eme...