Aaron Rindflesch's research while affiliated with Mayo Clinic - Rochester and other places

Purpose The purpose of this study was to explore pediatric physical therapists’ (PTs’) experiences including successes, challenges, and barriers with cross-cultural communication with Arabic-speaking Middle Eastern children and their families who require interpreter services. Methods Eight PTs consented to participate in qualitative dyadic interviews. Transcription and interviews were conducted virtually in Microsoft Teams. Quality criteria included member checking for validity and trustworthiness and bracketing to minimize investigator bias. Inductive thematic analysis was used to identify meaning units and major themes. Results The 6 themes that emerged were: fostering therapeutic relationships, practicing culturally sensitive care, communicating intentionally, experiencing successes, recognizing challenges, and tailoring a physical therapy plan of care. Representative quotations support each theme. Conclusions Therapists perceive their experiences with Arabic-speaking children, families, and interpreters positively despite challenges related to cultural and language barriers. In sharing their experiences, therapists demonstrated self-reflection, openness to learning, and desire to build strong therapeutic alliances.

Background: Student readiness for clinical education experiences is an important variable for clinical preceptors. Readiness has been reported from the viewpoints of clinicians, academic faculty, clinical preceptors, employers and novice graduate physical therapists. Perspectives from physical and occupational therapy students could better prepare preceptors in the acute care setting. Approach: Thematic analysis was conducted following the approach described by Braun and Clarke. The purpose of this study was to describe physical and occupational therapy student perceptions of readiness for full-time acute care clinical education experiences. Twenty-one physical and occupational therapy students in process of completing full-time clinical education experiences at a large academic medical centre were qualitatively interviewed in small groups. A two-stage iterative process of thematic inquiry was used to induce themes about student readiness for full-time acute care clinical experiences. Transcription, coding and thematic analysis were completed. Students also completed a one-time questionnaire with demographic and learner characteristic scales. Findings: Participants were on average 26.4 years old, predominantly female and White, and had completed one full-time clinical education experience prior to participation. Four major thematic categories of student readiness for acute care clinical experiences emerged: (1) mindset and willingness; (2) knowledge and experience; (3) communication and collaboration; and (4) planning and prioritising. Implications: Students report their readiness is facilitated by preceptors who can model flexibility, foster communication that promotes clinical reasoning, implement an orientation to the acute care culture and learning resources and scaffold roles and responsibilities to aid professional authority.

Aims: This study examined how the qualities of grit and resilience correlated with career achievements in physical therapists. The purpose of this study was to determine if select career achievements were correlated with 1) Original Grit Scale (Grit-O) scores, 2) Short Grit Scale (Grit-S) scores, or 3) Connor-Davidson Resilience Scale (CD-RISC) scores among Mayo Clinic School of Health Sciences Physical Therapy Program graduates from 2000-2018. Methods: Cross-sectional research design. Participants were 212 graduates between 2000 and 2018, inclusive. Participants completed the Grit-O, Grit-S, and CD-RISC scales and reported career achievements. Descriptive statistics were used to summarize the demographics, career achievements, grit, and resilience of the subjects. Point biserial and partial correlations were used to examine associations between Grit-O and Grit-S subscales, CD-RISC scores, and career achievements. Results: When controlled for gender and time since graduation, there were significant positive relationships between Grit-O Perseverance of Effort and 1) publication in a peer-reviewed journal and 2) attainment of an additional degree. Biological males were significantly more likely to have reported certain career achievements. Conclusion: Few of the expected relationships were found, possibly due to a lack of true relationships, a homogeneous population, ceiling effect, or inaccurate self-reports.

Purpose: The purposes of this study were to: 1) report levels of self-perceived grit among students in accredited Doctor of Physical Therapy (DPT) programs; 2) explore comparisons between grit and personal student factors; and 3) compare grit scores of DPT student to students in other healthcare professions. Methods: 1,524 enrolled students were surveyed from accredited DPT programs in the US in this cross-sectional research study. Surveys consisted of the 12-item Grit-O questionnaire and an additional questionnaire asking for a report of personal student factors. Non-parametric inferential statistics were conducted to compare Grit-O scores across categories of gender identity, age groups, year in school, race/ethnicity, and employment status of respondents. One-sample t-tests were used to compare DPT grit scores to those of students in other health professions previously reported in the literature. Results: DPT students from 68 programs responded to the surveys reporting mean grit score of 3.95 (± 0.45 SD) and median grit score of 4.00 (interquartile range [IQR] 3.75-4.25). Grit-O subscores in consistency of interest and perseverance of effort had median scores of 3.67 (IQR 3.17- 4.00) and 4.50 (IQR 4.17-4.67), respectively. Consistency of interest subscores were significantly greater in older students, and perseverance of effort subscores were statistically greater in African American respondents. In comparison to other studies, DPT grit scores were greater than nursing and pharmacy students and were comparable to medical students. Conclusion: DPT students who responded to our surveys perceive themselves as possessing relatively high levels of grit, especially in perseverance of effort.

Purpose: We examined lexical sophistication of written personal statements from physical therapy applicants to determine whether recurrence quantification analysis (RQA) indices distinguish higher- versus lower-scored candidates and correlate with other admissions variables. Methods: Written personal statements were extracted from 152 applications, coded numerically, and analyzed with RQA. Along with other RQA indices, determinism-representing predictability of words and phrases-was quantified. A receiver operating characteristic (ROC) curve analysis was used to examine discriminative validity of RQA indices to distinguish between top-10 and bottom-10 candidates. Correlation coefficients between RQA indices and other admissions variables (grade point averages, standardized exam, behavioral interview, and cumulative admissions scores) were also examined. Results: Determinism in personal statements was lower in top-scored (mean 7.38%) than bottom-scored candidates (mean 11.29%, p = 0.015), differentiated between them with 70% sensitivity (95% CI 34.8%-93.3%) and 100% specificity (95% CI 69.2%-100%), and correlated negatively with candidates' behavioral interview scores (r = -0.168, p = 0.039). Discussion: The greater expressive lexical sophistication characterized by lower determinism in personal statements provides information about candidates' writing proficiency as a component of their communication abilities that may not otherwise be assessed in traditional admissions variables.

Background and Purpose The Placement Process Task Force (PPTF), a combined effort of the Clinical Education Special Interest Group and the National Consortium of Clinical Educators, has developed recommendations for the placement process of students in full-time clinical education experiences following data collection from stakeholders. The PPTF submitted a report to both boards and highlights its methods and rationale for the recommendations here. Position and Rationale To reduce variability and administrative burden shared among stakeholders, there should be a common definition of the process. Additionally, a common clinical calendar should be developed and adopted with accepted deadlines for placement requests, offer acceptance, offer release, student assignment, and onboarding requirements. Training should be required for new directors of clinical education (DCEs) and site coordinators of clinical education (SCCEs) to initiate them to the common calendar. Only the DCE/ACCE or employed members of the DCE/ACCE team should be responsible for securing clinical education placement offers. Adoption of these recommendations will allow progress toward the goal of reducing administrative burden with the potential of creating opportunities for DCEs and SCCEs to participate in the advancement of clinical education development and scholarship. Discussion and Conclusion The current variability of placement processes commonly used in full-time clinical education has negative effects on SCCEs and clinics, DCEs and academic programs, and students. Reducing variability and administrative burden can result in additional productivity of stakeholders for tasks, such as clinical instructor development, student development, and clinical education research.

Background and purpose: Stroke is the leading cause of disability in the United States. Two-thirds of stroke survivors will require caregiver assistance. Evidence suggests the mental health of caregivers is closely related to patients' health outcomes. The timing of this study intersected with the beginning of the coronavirus disease-2019 (COVID-19) pandemic that required strict social distancing and hospital visitor policy changes. This study aims to answer the primary research question: What is the level and nature of stress experienced by caregivers of persons with newly-acquired stroke in the inpatient rehabilitation setting and how has the COVID-19 pandemic impacted the caregiver experience? Methods: Recruitment occurred from a single inpatient rehabilitation facility. Participants were administered the Perceived Stress Scale and then completed qualitative semistructured interviews. The investigators used a phenomenological, iterative approach to collect and analyze qualitative data. The data were independently coded and categorized before consolidated into primary themes and subthemes. Results: Eleven informal caregivers' perspectives generated 13 subthemes across 4 primary thematic categories: COVID-19 impact, concerns of the caregiver, coping strategies, and important aspects of the caregiver experience. COVID-19 social distancing necessitated new visitor policies, which presented additional challenges for caregivers. Discussion and conclusions: Caregiver attendance at therapy sessions and frequent, direct communication between staff and caregivers improved caregiver readiness for family member discharge following inpatient rehabilitation. This study shared perspectives from a distinctive time during the COVID-19 pandemic. If visitation for multiple therapy sessions is prohibited, we recommend taking alternative measures to keep the caregiver involved in the plan of care.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A326).

Background and Purpose/Objective Patients undergoing hematopoietic stem cell transplantation (HSCT) are at risk for strength impairments and activity limitations. Research describing how HSCT affects physical performance is limited. The purposes of this study were to report the short-term (≤30 days) effects of HSCT on physical performance and to compare changes among patients during the engraftment and recovery periods following HSCT. Methods: Design Prospective observational study. Setting Academic medical center. Patients Twenty-five adults 21 years and older undergoing HSCT. Intervention None. Measurements Measures were collected at 3 time points: (1) day of transplant; (2) 8 to 14 days posttransplant; and (3) 15 to 30 days posttransplant. Beside demographic data, the authors collected Short Physical Performance Battery (SPPB) scores, Functional Comorbidity Index scores, resting heart rate, and hospitalization status. Longitudinal changes in SPPB scores were analyzed with a generalized linear model (α = 0.05). Results SPPB scores were negatively associated with patients' body mass index values and resting heart rate measurements. Additionally, the hospitalization × time interaction was statistically significant. SPPB scores among nonhospitalized patients remained consistent across the testing periods but among hospitalized patients decreased from the day of transplant to both the 8 to 14 days (mean change = 4.0 points) and 15 to 30 days (mean change = 4.1 points) posttransplant time points. Conclusion Physical performance scores decreased in the first 30 days of recovery among patients who were hospitalized following HSCT, but not among patients who received transplant on an outpatient basis. Future studies to examine causes of and interventions for the reduction in physical performance among hospitalized patients post-HSCT are warranted.

Introduction Defining best practice in clinical education is currently a primary focus of the American Physical Therapy Association and the American Council of Academic Physical Therapy. Although professional standards exist for physical therapist clinical instructors (CIs), there is little published research regarding the pathway to achieving competence as a CI. Moreover, there is currently no published definition for competence as a CI within the profession of physical therapy (PT). This study attempts to describe the meaning of competence and the experience of achieving competence as perceived by both credentialed and noncredentialed CIs. Subjects Twenty-nine physical therapist CIs who had independently supervised at least one full-time physical therapist student served as the subjects for this study. Methods A phenomenological methodology was used to understand and interpret the meaning of CI competence and the experience of achieving competence from the CI participants' perspectives. Data were collected through focus group interviews and written statements and then were analyzed using thematic analysis. Results The journey to competence, though unique to each CI, included commonalities. An overarching theme of “Empowerment” emerged from the data analysis and was supported by 6 subthemes: (1) the meaning of competence, (2) my first student, (3) finding the way, (4) barriers to achieving competence, (5) confidence, and (6) lifelong learning. Participants' descriptions of the meaning of competence included the roles of skilled clinician, teacher, mentor, reflective learning, collaborator, and effective communicator. Discussion and Conclusion Findings can inform CIs striving for effectiveness in clinical teaching by defining the meaning of competence, as well as revealing a variety of pathways used to achieve competence. These examples could be helpful for Site Coordinators of Clinical Education, Directors of Clinical Education and others who teach CI development. The physical therapy education community and its professional bodies can use these findings to define CI competence and to direct future efforts and programs designed to prepare clinicians to effectively educate students in the clinical setting.

Objective: To compare patient outcomes following acute rehabilitation after total hip arthroplasty (THA) of two groups: patients treated by student physical therapists (SPTs) under licensed physical therapist (PT) supervision and by licensed PTs. Participants: Seventy-eight patients with rehabilitation managed by supervised SPTs and 78 treated by licensed PTs. Inclusion criteria were admission between 2010 and 2014, first-time THA, age 55 to 70 yrs, and research consent. Methods: Retrospective cohort review of electronic health records was conducted. The primary outcome measure was Activity Measure for Post-Acute Care (AM-PAC) 6 Clicks Basic Mobility Short Form. Outcomes: Patient base¬line and discharge outcomes measured by AM-PAC 6 Clicks were analyzed with mixed-model analysis of covariance. Results: No significant difference was found in AM-PAC score between patient groups, even after differences in body mass index and session number were controlled. AM-PAC mean (SD) scores of SPT-managed cases changed from 14.5 (2.4) at baseline to 18.2 (2.1) at discharge; of PT-managed cases, from 14.4 (2.4) to 18.2 (2.1). Outcomes were realized in fewer SPT-managed sessions than PT-managed sessions; distance ambulated was significantly greater in the PT-managed group. Discharge locations did not differ. Conclusion: AM-PAC scores after THA were equal whether patients were treated by supervised SPTs or licensed PTs.