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Physical therapists’ level of McKenzie education, functional outcomes, and utilization in patients with low back pain
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
H = 13.8, p = .003; H = 10, p = . 018; H = 11.2, p = .010) with the Canadian students reporting higher self-efficacy than the students in the American public school (U = 449, p = .002; U = 423 p = .001; U = 481, p = .003; U = 452, p = .001). For the Canadian school modest positive correlations were found between self reported literature review preparation and EPIC questions 1 (identify gaps in knowledge), 3 (conduct an online search), 4 (critically appraise method), 5 (critically appraise measurement) and 6 (interpret study results) (range of rho = .259 to .456, p = .05 to .01). Conclusion(s): On entering physical therapy programs, students may differ in pre-program EBP experience and confidence related to planning and conducting literature reviews, as well as confidence in patient-related EBP skills. Whether differences in EBP self-efficacy persist can be determined only with a longitudinal study, which is in progress. Students with self-reported experience with literature reviews reported greater self-confidence with searching and critically appraising the literature. Implications: Self-efficacy with EBP skills upon entry to physical therapy school is variable and may inform program admission requirements and curriculum planning to address students learning requirements. Keywords: EBP confidence; Admission requirements; Self-efficacy Funding acknowledgements: WR is a pre-doctoral fellow in the Rivers Lab; NS holds a CIHR New Investigator Award in Knowledge Translation. Ethics approval: Protocol approved by Rutgers, Chatham, and Sacred Heart Universities in the US and the University of and Toronto in Canada. http://dx.doi.org/10.1016/j.physio.2015.03.511 Research Report Platform Presentation Number: RR-PL-830 Sunday 3 May 2015 10:56 Room 328–329 PHYSICAL THERAPISTS’ LEVEL OF MCKENZIE EDUCATION, FUNCTIONAL OUTCOMES, AND UTILIZATION IN PATIENTS WITH LOW BACK PAIN D. Deutscher 1 , M.W. Werneke 2 , D. Gottlieb 1 , J.M. Fritz 3,4 , L. Resnik 5,6 1 Maccabi
Healthcare Services, Physical Therapy, Tel-Aviv, Israel; 2 CentraState Medical Center, Freehold, NJ, USA; 3 Intermountain Healthcare, Salt Lake City, UT, USA; 4 University of Utah, Physical Therapy, Salt Lake City, UT, USA; 5 Providence VA Medical Center, Providence, RI, USA; 6 Brown University, Department of Health Services, Policy and Practice, Providence, RI, USA Background: McKenzie method is commonly used in treating patients with LBP.
eS313
Purpose: Examine associations between McKenzie training, functional status (FS) at discharge, and number of physical therapy visits (utilization), for patients receiving physical therapy for low back pain (LBP). Methods: A McKenzie post-graduate educational program was initiated in a large outpatient physical therapy service. FS data were collected at intake and at discharge. Separate hierarchical linear mixed models were used to examine associations between physical therapists’ McKenzie training level (none, Parts A, B, C, D, & credential), FS score at discharge, and utilization, controlling for patient risk factors. Results: Final dataset included 20882 patients (mean age (SD) = 51(16) years, 57% women), who completed FS surveys both at admission and discharge. Patients treated by physical therapists with any McKenzie training had better outcomes (additional 0.7 to 1.3 FS points; P < .05– < .001), and fewer visits (0.6 to 0.9 P < 0.001), compared with patients treated by physical therapists with no training. For patients treated by therapists with no versus some McKenzie education, 65% versus 70% achieved at least the minimal clinically important improvement (MCII), respectively. There were no significant differences in outcomes or utilization by level of McKenzie training. Conclusion(s): There was a slightly greater improvement of 0.7–1.3 points in discharge FS in patients receiving physical therapy for LBP by physical therapists who underwent McKenzie training. This difference was clinically important for an additional 5% of patients who achieved the MCII if treated by therapists with some McKenzie training. Reduction in physical therapy utilization was 0.6–0.9 visits, with fewest visits utilized by patients of physical therapists at the McKenzie Part D and credentialed level. Implications: Together these findings suggest improved cost-effectiveness at advanced McKenzie training levels. Ways to improve ongoing education and patient outcomes were proposed. Keywords: Continuing education; Cost-effectiveness; McKenzie Funding acknowledgements: This study was funded by Maccabi Healthcare Services. Ethics approval: This project was approved by the Institutional Review Board for the Protection of Human Subjects of Maccabi Healthcare Services, Israel. http://dx.doi.org/10.1016/j.physio.2015.03.512
H = 13.8, p = .003; H = 10, p = . 018; H = 11.2, p = .010) with the Canadian students reporting higher self-efficacy than the students in the American public school (U = 449, p = .002; U = 423 p = .001; U = 481, p = .003; U = 452, p = .001). For the Canadian school modest positive correlations were found between self reported literature review preparation and EPIC questions 1 (identify gaps in knowledge), 3 (conduct an online search), 4 (critically appraise method), 5 (critically appraise measurement) and 6 (interpret study results) (range of rho = .259 to .456, p = .05 to .01). Conclusion(s): On entering physical therapy programs, students may differ in pre-program EBP experience and confidence related to planning and conducting literature reviews, as well as confidence in patient-related EBP skills. Whether differences in EBP self-efficacy persist can be determined only with a longitudinal study, which is in progress. Students with self-reported experience with literature reviews reported greater self-confidence with searching and critically appraising the literature. Implications: Self-efficacy with EBP skills upon entry to physical therapy school is variable and may inform program admission requirements and curriculum planning to address students learning requirements. Keywords: EBP confidence; Admission requirements; Self-efficacy Funding acknowledgements: WR is a pre-doctoral fellow in the Rivers Lab; NS holds a CIHR New Investigator Award in Knowledge Translation. Ethics approval: Protocol approved by Rutgers, Chatham, and Sacred Heart Universities in the US and the University of and Toronto in Canada. http://dx.doi.org/10.1016/j.physio.2015.03.511 Research Report Platform Presentation Number: RR-PL-830 Sunday 3 May 2015 10:56 Room 328–329 PHYSICAL THERAPISTS’ LEVEL OF MCKENZIE EDUCATION, FUNCTIONAL OUTCOMES, AND UTILIZATION IN PATIENTS WITH LOW BACK PAIN D. Deutscher 1 , M.W. Werneke 2 , D. Gottlieb 1 , J.M. Fritz 3,4 , L. Resnik 5,6 1 Maccabi
Healthcare Services, Physical Therapy, Tel-Aviv, Israel; 2 CentraState Medical Center, Freehold, NJ, USA; 3 Intermountain Healthcare, Salt Lake City, UT, USA; 4 University of Utah, Physical Therapy, Salt Lake City, UT, USA; 5 Providence VA Medical Center, Providence, RI, USA; 6 Brown University, Department of Health Services, Policy and Practice, Providence, RI, USA Background: McKenzie method is commonly used in treating patients with LBP.
eS313
Purpose: Examine associations between McKenzie training, functional status (FS) at discharge, and number of physical therapy visits (utilization), for patients receiving physical therapy for low back pain (LBP). Methods: A McKenzie post-graduate educational program was initiated in a large outpatient physical therapy service. FS data were collected at intake and at discharge. Separate hierarchical linear mixed models were used to examine associations between physical therapists’ McKenzie training level (none, Parts A, B, C, D, & credential), FS score at discharge, and utilization, controlling for patient risk factors. Results: Final dataset included 20882 patients (mean age (SD) = 51(16) years, 57% women), who completed FS surveys both at admission and discharge. Patients treated by physical therapists with any McKenzie training had better outcomes (additional 0.7 to 1.3 FS points; P < .05– < .001), and fewer visits (0.6 to 0.9 P < 0.001), compared with patients treated by physical therapists with no training. For patients treated by therapists with no versus some McKenzie education, 65% versus 70% achieved at least the minimal clinically important improvement (MCII), respectively. There were no significant differences in outcomes or utilization by level of McKenzie training. Conclusion(s): There was a slightly greater improvement of 0.7–1.3 points in discharge FS in patients receiving physical therapy for LBP by physical therapists who underwent McKenzie training. This difference was clinically important for an additional 5% of patients who achieved the MCII if treated by therapists with some McKenzie training. Reduction in physical therapy utilization was 0.6–0.9 visits, with fewest visits utilized by patients of physical therapists at the McKenzie Part D and credentialed level. Implications: Together these findings suggest improved cost-effectiveness at advanced McKenzie training levels. Ways to improve ongoing education and patient outcomes were proposed. Keywords: Continuing education; Cost-effectiveness; McKenzie Funding acknowledgements: This study was funded by Maccabi Healthcare Services. Ethics approval: This project was approved by the Institutional Review Board for the Protection of Human Subjects of Maccabi Healthcare Services, Israel. http://dx.doi.org/10.1016/j.physio.2015.03.512