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Pediatric Physical Therapy:
Section Information: Abstracts of Platform and Poster Presentations for the 2005 Combined Sections Meeting: Poster Presentations

DECISION MAKING FOR PHYSICAL THERAPIST SERVICE DELIVERY IN SCHOOLS: A NATIONWIDE ANALYSIS BY GEOGRAPHIC REGION

Kaminker, M K.; Chiarello, L A.; Chiarini, J A.

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Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA

PURPOSE/HYPOTHESIS: This study investigated the relationship between geographic practice location and recommendations for context (environment) and frequency of physical therapist service delivery in schools.

NUMBER OF SUBJECTS: Participants were 626 school-based physical therapists (response rate = 61.6%), from all 50 states, who were members of the Section on Pediatrics of the American Physical Therapy Association.

MATERIALS/METHODS: A secondary analysis was conducted using the database from the nationwide survey by the first two authors that explored decision making among school-based physical therapists. Four case descriptions were presented in the survey: 2 preschool girls with developmental delay (1 with and 1 without cognitive impairment) and a boy with cerebral palsy (at 6 years and again at 12 years of age). This study compared survey responses among the 4 geographic regions designated by the United States Census. Descriptive statistics summarized the survey findings. Data were analyzed using analyses of variance, paired-samples t tests, chi-square tests for independence, Tukey tests, Kruskal-Wallis tests, and Mann-Whitney U tests.

RESULTS: For all 4 clinical cases, a combination of service-delivery contexts (both natural and isolated settings) was preferred by the highest percentage of respondents from every region of the country (41–78.2%). Fewer respondents from the Northeast (4–16.8%) recommended providing services exclusively in natural settings, as compared to therapists from the Midwest (13.7–34.6%), West (14–37.5%), and South (19.8–39.7%). For each case, respondents from the Northeast recommended at least 1 more session of direct service per month (means = 3.7–7.6) than those from the other regions. Respondents from the West recommended the second highest mean monthly frequencies (2.5–5.5), while those from the South (1.6–4.7) and Midwest (1.6–4.5) recommended the lowest frequencies. The largest discrepancy in mean monthly frequencies was between the Northeast (7.6) and Midwest (4.5) for the case of the 6-year-old boy. When the respondents ranked the following factors on their degrees of importance in decision making, the median ranks for all regions were: 1.) often for past practice, 2.) often for state policies, 3.) sometimes for administrative input, and 4.) rarely for budgetary constraints. A statistically significant difference among regions was found for budgetary constraints, ranked by therapists from the Midwest as more than rarely important by the highest percentage (36.2%) of respondents.

CONCLUSIONS: This study found an association between geographic region of practice among school-based physical therapists and some aspects of clinical decision-making.

CLINICAL RELEVANCE: These findings raise our awareness of regional differences in school-based practice patterns and factors that influence clinical decisions. Further research may elucidate the reasons for these differences and may lead to guidelines for best practice in schools across regions.

© 2005 Lippincott Williams & Wilkins, Inc.

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