Secondary Logo

Journal Logo

Integration of Safe Patient Handling and Mobility Principles in Professional Physical Therapist Education

A Case Report

Haines, Jamie PT, DScPT, NCS; Arnold, Margaret PT, CEES, CSPHP

Journal of Physical Therapy Education: June 2019 - Volume 33 - Issue 2 - p 113–125
doi: 10.1097/JTE.0000000000000080
Case Report
Free
SDC

Background and Purpose. Safe patient handling and mobility (SPHM) programs are being used across the country to safely transport and mobilize patients while at the same time reducing injury risk to caregivers, including physical therapists (PT) and physical therapist assistants (PTA). The American Physical Therapy Association has called PTs and PTAs to not only use the concepts of SPHM in clinical practice, but also be leaders in utilization, development, and implementation of SPHM programs, including training and education of other health care team members. Perlow, et al have recommended that SPHM content be integrated into Doctor of Physical Therapy (DPT) education. This case report outlines 1 current module used to deliver such content.

Case Description. A neurologic interventions course within the DPT curriculum was selected using a framework that linked content, objectives, and learning activities with relevant Normative Model criteria and Physical Therapist Code of Ethics to improve student self-efficacy with SPHM content. Primary goals were to improve student awareness about risk and impact of work-related musculoskeletal disorders, expose students to the expected role of the PT as an advocate for and educator in SPHM programs, and provide hands-on experience with SPHM technologies. The 6-hour session was completed in 1 day with a 1-hour lecture and 5 hours with a variety of hands-on activities.

Outcomes. Student learning was assessed through a pre–post class questionnaire, documentation/discussion of experiences, and presentations of student-generated neurologic interventions using SPHM equipment. Awareness of increased risk of injury, limits of 'good' body mechanics, and feasibility of using SPHM technologies to improve the quality of physical therapy practice dramatically increased.

Discussion. Students should participate in a variety of learning activities threaded through the curriculum to provide sufficient hands-on opportunities to improve self-efficacy in using SPHM principles in rehabilitation. By developing a basic level of competency with SPHM principles, students may be more likely to adopt SPHM as a professional value once graduated. Improvements to this model, recommendations for SPHM integration into DPT curricula, and research opportunities are discussed.

Conclusion. We have provided 1 model that embeds SPHM content into entry-level physical therapist education. In doing so, educators are advancing physical therapy skills needed to apply evidenced-based therapeutic principles in difficult to move patients while reducing risk of injury to students and new graduates of the profession.

Jamie Haines is the Assistant Professor, in the Doctoral Program in Physical Therapy at the Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mont Pleasant, MI 48859 (haine1jj@cmich.edu). Please address all correspondence to Jamie Haines.

Margaret Arnold is the CEO at Inspire Outcomes, LLC.

Margaret Arnold is owner of Inspire outcomes LLC, which is a SPHM company and receives money from consulting and sale of a harness for rehabilitation. Jamie Haines reports no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.aptaeducation.org).

Received December 08, 2018

Accepted October 09, 2018

Back to Top | Article Outline

BACKGROUND AND PURPOSE

Physical therapy is a physically demanding job. Evidence points to better patient outcomes with interventions that are early and more frequent,1-3 which include higher repetitions of movement4-6 and higher exercise intensities.6,7 However, epidemiological research shows that frequently lifting and moving patients increases risk of work-related musculoskeletal disorders (WMSDs) and injuries to PTs,8,9 including PT students.10 Safe patient handling and mobility (SPHM) programs help decrease risk of injury11-13 and can promote early and frequent patient mobility.14-16 Physical therapist professional education does not routinely include principles of SPHM, and thus, to protect therapists and promote evidence-based recovery principles, more exposure is needed in curricula.

For optimal motor relearning after neurologic insult, patients should perform thousands of repetitions1,5,17-19 during meaningful, task-specific activities5,17-19 that allow for error augmentation and adaptations in real time.20 Staffing and time constraints, working with patients of size, and safety concerns for both patient and therapist make applying these principles in rehabilitation challenging.14 Physical therapists do get injured while rehabilitating their patients,8,21,22 and the lifetime incidence of PT injuries related to handling patients is 91%.9 The impact of WMSDs on therapists includes altered lifestyle and restricted recreational activities.9 In addition, injured therapists have reported compromising their treatment interventions because of pain.21 PT students have also reported injuries22,23 and bodily pain24,25 while working with patients even before they graduate from physical therapy school. In a nonexperimental prospective cohort study, Campo evaluated associations between physical therapy work and WMSDs and found that therapists who transferred patients 6–10 times per day had more than double the odds of developing low back injuries than those who did no patient transfers.26 Implementing the evidence for higher repetitions of movement more frequently could expose therapists to greater risk of injury and bodily pain.

Safe patient handling and mobility programs may provide the link to implementing the evidence without increasing risk of therapist injuries. Safe patient handling and mobility programs include the use of specialized equipment (powered and nonpowered patient lift/assist devices), patient assessment protocols, facility risk assessments, no-lift policies, staff training, and root cause analysis.27 Benefits of SPHM programs include reduced incidence of injuries11,12 and musculoskeletal complaints,13,28 increased job satisfaction in multiple disciplines,12,29 decreased worker compensation claims,12,13 employee turnover,12 and lost work days among health care workers across all care settings.13,14,16,30,31,32 In addition, SPHM equipment provides physical and occupational therapists with more options for therapeutic activities, especially when used with medically complex and bariatric patient populations.15 Therapists have reported getting patients up sooner, more frequently, and for longer periods of time when SPHM equipment is used.14,16,33

The American Physical Therapy Association (APTA) has called PTs and PTAs to use the concepts of SPHM in clinical practice and to be leaders in utilization, development, and implementation of these programs, including training and education of other health care team members.34 Increasingly, PTs are working in facilities with SPHM programs, and students must be prepared to work in these environments. Stevenson10 found that PT students who received SPHM content and training in professional programs were more likely to have positive attitudes and be leaders in the clinic; however, only 18% of students surveyed reported learning SPHM as a standard of practice within the curriculum. Perlow35 recommended that SPHM content be integrated into Doctor of Physical Therapy (DPT) education and threaded throughout the DPT program. Nursing programs that have implemented SPHM content into the curriculum have reported reduction in injuries in graduates36 and enthusiasm from faculty and students37 once implemented.

Student self-efficacy plays an important role in transferring knowledge from the classroom environment into the clinical realm and is linked to improved professional behaviors.38 Self-efficacy is defined as “people's judgment of their capabilities to organize and execute courses of action required to attain designate types of performances.”39 Students with strong self-efficacy perform academic tasks with greater confidence, undertake challenging tasks more readily, and persist longer during difficulties.40 This case report outlines 1 example of an educational intervention, with focus on student self-efficacy, to integrate SPHM concepts into the DPT curriculum.

Back to Top | Article Outline

CASE DESCRIPTION

The educational intervention took place in a mid-west DPT program during a third-year neurologic interventions course. This course required extensive manual handling because students applied neuroplasticity recovery principles in complex cases. The SPHM content aligned with many course objectives, and the instructor allotted 6 hours for the module (1 hour lecture, followed by 5 hours of laboratory activities). The module had 3 overarching goals: 1) Integrate current evidence related to WMSD and SPHM with the impact on therapist safety and quality of life, 2) Consider the professional responsibility of PTs as advocates for SPHM principles, and 3) Appraise the role of SPHM principles to improve functional recovery for people with neurologic conditions.

Back to Top | Article Outline

Design of Educational Intervention

The framework for this module linked primary content, terminal behavioral objectives, and learning activities with relevant Normative Model criteria41 and Physical Therapist Code of Ethics42 (Table 1). Eight relevant professional practice expectations were identified from these documents including clinical reasoning, applying current knowledge, accountability, safety, implementation of interventions, risk management, legal and professional obligations, and organizational behaviors that benefit patients. Eleven terminal behavioral objectives addressed these practice expectations and guided the development of the teaching activities. Sources of self-efficacy come from performance accomplishment of similar tasks (mastery experiences), positive feedback/suggestions from feedback or peers (verbal persuasion), observations of others' successes or failures (vicarious experiences), and self-evaluation of physiological (emotional) states.39 Various dynamic instructional activities were used to enhance student self-efficacy with the material. Other resources included the APTA vision statement,43 APTA position statement on SPHM,34 APTA description of physical therapist practice,44 and Standards of Required Elements for Accreditation for Physical Therapist Education Program.44

Table 1-a

Table 1-a

Table 1-b

Table 1-b

Back to Top | Article Outline

Assessment of Terminal Behavioral Objectives

Formal Assessment

Students completed a 2-part survey before class. Part 1 (questions 1–11) included student demographic information. Part 2 (questions 12–22) captured student awareness and confidence with SPHM content and was repeated after class to determine change from baseline. The survey was adapted with permission from Olkowski and Stolfi,33 who originally surveyed acute care PTs regarding their SPHM perceptions and practices. Laboratory worksheets assessed terminal behavioral objectives related to integration of SPHM principles. Students rated their perceived exertion (RPE), quality of intervention, bodily stress, and quantity (repetitions, steps, or time) achieved with manual and equipment-assisted interventions.

Back to Top | Article Outline

Informal Assessment

Terminal behavioral objectives related to professional role and responsibilities in SPHM were informally assessed through group discussion but were not objectively measured. Similarly, objectives related to integration of SPHM principles during neurologic interventions were assessed through direct observation by faculty, and student presentations, but were not quantified or documented.

Back to Top | Article Outline

Instructional Activities

Lecture

A 1-hour face-to-face lecture reviewed current evidence on neurorehabilitation principles, epidemiology of WMSDs, and the impact of these injuries on therapists and on patient care. The history of SPHM content development, the APTA position on SPHM, current legislation, and the role of PTs in advocating for SPHM were also presented. Several authentic patient case studies in video format to demonstrate principles of neurorehabilitation with SPHM equipment concluded the lecture.

Back to Top | Article Outline

Laboratory

Vendors supplied the SPHM equipment because the university did not have equipment on site. A variety of devices were available for students to work with. These included powered and nonpowered sit-to-stand devices, a floor-based total lift, a portable overhead gantry system with a range of slings and harnesses, and friction-reducing sheets.

Groups of 4–5 students reviewed a case study. One student from each group role-played the patient, with guidance from faculty. Other group members attempted to engage them in an assigned rehabilitative activity using only manual handling. During the activity, students documented RPE, joint/muscle stress, quality of the intervention, and quantity of the assigned activity completed (reaching in sitting, repeated sit to stand, standing/stepping, or walking). Faculty then introduced SPHM equipment through demonstration and student exploration with focus on how to incorporate the equipment during the assigned activities. Students repeated the interventions using SPHM equipment and documented their findings.

As a follow-up activity, students were given time to create their own plan of care with specific interventions for the case study, integrating SPHM equipment. Faculty prompted students to consider the evidence and consider activity progressions and regressions as they worked with the “patients.” Students presented activities citing rationale and evidence to support their clinical reasoning. Activities were shared through videos and photographs, which were available to students for future clinical reference. Appendix A (Supplemental Digital Content 1, http://links.lww.com/JOPTE/A41) contains laboratory worksheets. Examples of students performing activities are shown in Figures 1–2.

Figure 1

Figure 1

Figure 2

Figure 2

Back to Top | Article Outline

OUTCOMES

Survey Results

Part 1 Student Demographics

Twenty-four students completed both parts of the survey. There were 21 female and 3 male students (Table 2). All students were in the third year of the DPT program. A majority of the students (67%) had completed an outpatient orthopedic clinical experience, with 12.5% completing an outpatient neurologic experience. Twenty percent of students had experiences in either a skilled nursing facility, inpatient rehabilitation, or acute care clinical experience. According to the survey, none of the students went through a formal training program with SPHM equipment while on their clinical experiences, but 21% did indicate that they used SPHM equipment for gait or transfer training. Students who had used SPHM equipment reported using ceiling lifts (4%), floor-based lifts (8%), walking harness systems (8%), and sit-to-stand lifts (8%).

Table 2-a

Table 2-a

Table 2-b

Table 2-b

Table 2-c

Table 2-c

Back to Top | Article Outline

Part 2 Safe Patient Handling and Mobility Pre–post Intervention Survey Results

Pretest results showed strong levels of previous knowledge in several areas. All the students reported that they could state the harmful effects of immobility, and most students (71%) could identify 1–2 limitations of using manual assistance in patients who were challenging to move. Most of the students (75%) agreed or strongly agreed that there is sufficient evidence to support the use of SPHM equipment and practices, and all students agreed that these practices are feasible during physical therapy sessions. In addition, 96% students reported that the quality of physical therapy is not diminished by the use of SPHM equipment.

In contrast, only 21% of students were confident in their ability to use SPHM equipment on the pretest. After the intervention, 87% of students either agreed or strongly agreed that they were confident in their ability to use SPHM equipment. Similarly, before the class, only 4% of students were familiar with the research related to therapist injury during manual handling. This improved to 83% posttest. Before the class, none of the students reported being aware of the legislation related to SPHM or the APTA position statement. After the intervention, these improved to 71% and 67%, respectively.

Back to Top | Article Outline

Laboratory Worksheet Results

Table 3 summarizes students' average rate of perceived exertion in their role as the treating therapist on a 0–10 scale, (0 = no exertion and 10 = maximal exertion), quantity of task performance (repetitions, minutes, or steps), and the quality of the intervention (good, fair, or poor), during assigned manual and SPHM equipment-assisted activities.

Table 3

Table 3

Back to Top | Article Outline

Repeated Sit-to-Stand Task

Using SPHM equipment, students were able to achieve greater repetitions of sit to stand with dramatically lower rates of perceived exertion. This was consistent across all 8 students performing this task (Figures 3A, B). Seven of 8 students rated the quality of their intervention as good with SPHM equipment versus all 8 students reporting quality as poor with manual assistance.

Figure 3

Figure 3

Back to Top | Article Outline

Walking to the Bathroom Task

All 3 students completing this task reported lower RPE and greater number of steps when using the SPHM equipment when compared with manually performing the task (Figures 4A, B) None of the students reported treatment intervention quality as “good” when using manual assistance. When using the equipment, all 3 rated the quality as “good.”

Figure 4

Figure 4

Back to Top | Article Outline

Repeated Reaching in Sitting Task

Attempting to complete 30 repetitions of reaching in the sitting position using manual assistance, the 3 students assigned to this task achieved 5, 15, and 5 repetitions with an RPE of 7/10, 6/10, and 6/10, respectively. All rated the quality of intervention as “fair.” With SPHM equipment, all 3 students achieved 30 repetitions, with RPE of 1/10, 2/10, and 1/10, respectively (Figures 5A, B). All rated the quality of intervention with SPHM as “good.”

Figure 5

Figure 5

Back to Top | Article Outline

Standing Balance Task

During manually assisted standing balance, 3 of the 4 students performing the task achieved all 5 minutes. One student was unable to complete even 1 minute of standing balance because of difficulty holding the patient up. Rate of perceived exertion ratings by student during manual assistance were 9/10, 8/10, 9/10, and 6/10, and quality of intervention was rated as “fair” by 3 students and “good” by 1 student. With use of the equipment, all 4 students achieved the 5-minute goal in standing with RPE at 1–2/10 (Figures 6A, B).

Figure 6

Figure 6

Back to Top | Article Outline

DISCUSSION

The need for SPHM education in physical therapy curriculum has been clearly identified.10,35 Previous studies have recommended integration of SPHM content into physical therapy education33; however, this is the first case report to describe an example of such a learning module in detail. Similar to acute care therapists' responses in the study by Olkowski and Stolfi,33 students were aware that SPHM equipment was available in some practice settings. They had some baseline knowledge about the evidence to support the use of SPHM and agreed that it was feasible to use and did not diminish the quality of care. However, students were not confident in their abilities to integrate SPHM principles into their treatment interventions. This may provide an explanation for the findings of Stevenson et al10 that identified a knowledge–practice gap between what students know and how comfortable they are applying the knowledge in a variety of clinical situations.

Laboratory activities were designed to promote knowledge transfer from cognitive to psychomotor domain through physical experience with and without SPHM equipment (mastery experiences). Students were asked to critically appraise the SPHM equipment by comparing and contrasting their experiences (verbal persuasion). When students compared their laboratory worksheets, it was clear that their “patients” were able to achieve more steps, more repetitions, and longer activity times in the equipment than when manual assistance was provided. They also documented higher quality interventions when using the SPHM equipment. Students also remarked on the noticeable difference in their perceived exertion, with little to no bodily stress while using the equipment. Students did report that in some cases, the equipment itself was challenging to manage, and it took some time to learn how to apply slings and set their “patients” up in the equipment.

During informal discussion, students reported that the additional time allotted to develop, implement, and document their own plan of care using the SPHM equipment helped them to further consolidate their skills and integrate knowledge taught in this class with previous classes. They reported that group presentations helped them defend their clinical reasoning in designing a plan of care that was safe for both the patient and themselves (emotional state and vicarious experiences).

PTs are expected to be advocates and leaders in education for SPHM. In order for students to be better prepared for this role, improving student self-efficacy regarding SPHM content is paramount. This module improved DPT students' knowledge, awareness, and self-reported confidence with SPHM equipment in neurorehabilitation, meeting the overarching goals of the educational intervention.

Back to Top | Article Outline

Recommendations for Improvements to the Current Model

Recommendations for improvements to this module are grounded in concepts from social learning theory, in particular, the development of perceived self-efficacy and modeling in student populations.46 The activities developed for this module allowed students to observe how SPHM principles are used by experienced therapists (modeling) and experience success (and failures) with the equipment through hands-on opportunities (mastery experiences). Students presented their activities with rationale to the class (regulation of physiologic states) and verbally defended/received feedback about the activities presented by other students and instructors (verbal persuasion).

In learning new content, hands-on practice and observation, critical thinking, feedback from experts, and collaboration with others help with transfer of knowledge and skills into clinical practice. Students must be given sufficient opportunities to develop context-specific self-efficacy to translate SPHM skills from academia into practice. Three recommendations to further improve successful integration of SPHM content into physical therapist professional education are proposed.

Back to Top | Article Outline

Recommendations for Safe Patient Handling and Mobility Principles to be Threaded Throughout the Curriculum

According to Bandura,39 mastery of content requires repeated exposures through a variety of active learning strategies. Safe patient handling and mobility content should be included in foundational patient care courses and embedded throughout the curriculum. Ideally, SPHM should be an integral component of any patient care scenario where lifting patients is required to promote recovery, but safe lifting levels are exceeded.47 Repeated observational learning and mastery experiences will improve student self-efficacy to merge legal and professional obligations and clinical decision making across the care continuum.

Research also suggests that PT educational programs need both didactic support of SPHM content and partnerships with clinical sites to reinforce skills developed in the curriculum and improve competency during clinical education experiences.25 Clinical educators are influential in shaping student attitudes, and students who actively participate in SPHM behaviors in the clinic are more likely to advocate for SPHM in the profession.10

Back to Top | Article Outline

Recommendations for Entry-Level Doctor of Physical Therapy Programs to Have Continuous Access to Safe Patient Handling and Mobility Equipment

Bandura39 advocates multiple context-specific hands-on experiences to achieve self-efficacy, which increase the odds of translating skills to clinical practice. Continuous access to SPHM equipment (as with other equipment such as goniometers, walkers, and wheelchairs) allows students and faculty to easily access and integrate use of the equipment during case scenarios at any time. Ultimately, SPHM principles should be an automatic consideration for both faculty and students during clinical decision making. The authors recommend that schools invest in having continuous access to (through equipment purchase or contract with vendors) a variety of SPHM equipment (Table 4) to ensure availability of these types of experiences throughout the curriculum.

Table 4

Table 4

Back to Top | Article Outline

Recommendations for Outcomes Research

Stevenson et al10 reported on student attitudes regarding SPHM use after graduation. At present, there are no reported measures of SPHM knowledge transfer from the classroom into clinical practice in the physical therapy literature. Future research should help determine optimal amount of time and placement of SPHM content within the curriculum to achieve entry-level competency and translation to clinical practice. Documenting changes in student self-efficacy should be included for this content. Future research should also assess the impact of SPHM content within the DPT curriculum on new graduate therapists' injuries.

Back to Top | Article Outline

Limitations

The SPHM module only applies to the experience of a small group of students in 1 course embedded in 1 DPT program. The learner survey did not assess achievement of higher-order learning objectives, students' ability to apply their learning in a clinical situation, or their self-efficacy. The authors also acknowledge that observing and measuring classroom behavior is not the same as ensuring that the behavior will carry over into clinical practice.

Back to Top | Article Outline

CONCLUSION

The APTA calls on PTs to be leaders and advocates of SPHM and to lead the education of others. Perlow, et al states “physical therapist educators can influence future attitudes and practice by preparing student PTs to make sound clinical decisions about the use of both manual and mechanically assisted patient mobility.”35 We have provided 1 model, with recommendations for improvement, that embeds SPHM content into entry-level physical therapist education. In doing so, educators are advancing skills associated with SPHM to apply evidenced-based recovery principles for patients who are difficult to move while reducing risk of injury to students and new PT graduates.

Back to Top | Article Outline

REFERENCES

1. Klein K, Mulkey M, Bena JF, Albert NM. Clinical and psychological effects of early mobilization in patients treated in a neurologic ICU: A comparative study. Crit Care Med. 2015;43:865–873.
2. Bernhardt J, Churilov L, Ellery F, et al. Prespecified dose-response analysis for a very early rehabiliation (AVERT). Neurology. 2016;86:2138–2145.
3. Cameron S, Ball I, Cepinskas G, et al. Early mobilibation in the critical care unit: A review of adult and pediatric literature. J Crit Care. 2015;30:664–672.
4. Kleim J, Jones T. Principles of experiences-dependent neural plasticity: Implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51:S225–S239.
5. Hornby TG, Straube DS, Kinnaird CR, et al. Importance of specificity, amount, and intensity of locomotor training to improve ambulatory function in patients poststroke. Top Stroke Rehabil. 2011;18:293–307.
6. Ploughman M, Kelly L. Four birds with one stone? Reparative, neuroplastic, cardiorespiratory, and metabolic benefits of aerobic exercise poststroke. Curr Opin Neurol. 2016;29:684–692.
7. Ahlskog J. Aerobic exercise: Evidence for a direct brain effect to slow Parkinson disease progression. Mayo Clin Proc. 2018;93:360–372.
8. Vieira ER, Svoboda S, Belniak A, et al. Work-related musculoskeletal disorders among physical therapists: An online survey. Disabil Rehabil. 2016;38:552–557.
9. Campo M, Weiser S, Koenig KL, Nordin M. Work-related musculoskeletal disorders in physical therapists: A prospective cohort study with 1-year follow-up. Phys Ther. 2008;88:608–619.
10. Stevenson J, Hinsch C, Bartold K, Briggs L, Tyler L. Exploring the influence of clinical and classroom training on advocacy for safe patient handling practices among student physical therapists. J Phys Ther Educ. 2015;29:60–69.
11. Tullar J, Brewer S, Amick BC III, et al. Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector. J Occup Rehabil. 2010;20:199–219.
12. ANA's national standards on SPHM released safe patient handling and mobility. Am Nurse. 2013;45:12.
13. Li J, Wolf L, Evanoff B. Use of mechanical patient lifts decreased musculoskeletal symptoms and injuries among health care workers. Inj Prev. 2004;10:212–216.
14. Arnold M, Wilson C, McIlvaine J, Labreche M, Stevens LM. Integrating mobility and safe patient handling: Practical considerations for interdisciplinary care. Am J Safe Patient Handl Mov. 2015;5:S1–S21.
15. Darragh AR, Campo MA, Frost L, Miller M, Pentico M, Margulis H. Safe-patient-handling equipment in therapy practice: Implications for rehabilitation. Am J Occup Ther. 2013;67:45–53.
16. Campo M, Shiyko MP, Margulis H, Darragh AR. Effect of a safe patient handling program on rehabilitation outcomes. Arch Phys Med Rehabil. 2013;94:17–22.
17. Arya KN, Verma R, Garg RK, Sharma VP, Agarwal M, Aggarwal GG. Meaningful task-specific training (MTST) for stroke rehabilitation: A randomized controlled trial. Top Stroke Rehabil. 2012;19:193–211.
18. Nilsen DM, Gillen G, Geller D, Hreha K, Osei E, Saleem GT. Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: An evidence-based review. Am J Occup Ther. 2015;69:1–14.
19. Bogey R, Hornby TG. Gait training strategies utilized in poststroke rehabilitation: Are we really making a difference? Top Stroke Rehabil. 2007;14:1–8.
20. Reisman DS, McLean H, Keller J, Danks KA, Bastian AJ. Repeated split-belt treadmill training improves poststroke step length asymmetry. Neurorehabil Neural Repair. 2013;27:460–468.
21. Darragh AR, Huddleston W, King E. Work-related musculoskeletal disorders among occupational and physical therapists. Am J Occup Ther. 2009;63:351–362.
22. Cromie JE, Robertson VJ, Best MO. Work-related musculoskeletal disorders and the culture of physical therapy. Phys Ther. 2002;82:459–472.
23. Glover W, McGregor A, Sullivan C, Hague J. Work-related musculoskeletal disorders affecting members of the Chartered Society of Physiotherapy. Physiotherapy. 2005;91:138–147.
24. Kneafsey R, Haigh C. Learning safe patient handling skills: Student nurse experiences of university and practice based education. Nurse Educ Today. 2007;27:832–839.
25. Kneafsey R, Ramsay J, Edwards H, Callaghan H. An exploration of undergraduate nursing and physiotherapy students' views regarding education for patient handling. J Clin Nurs. 2012;21:3493–3503.
26. Campo M, Darragh AR. Work-related musculoskeletal disorders are associated with impaired presenteeism in Allied Health Care Professionals. J Occup Environ Med. 2012;54:64–70.
27. Nelson AL, Motacki K, Menzel N. The Illustrated Guide to Safe Patient Handling and Movement. New York, NY: Springer Publishing Company; 2009.
28. Collins JW, Wolf L, Bell J, Evanoff B. An evaluation of a “best practices” musculoskeletal injury prevention program in nursing homes. Inj Prev. 2004;10:206–211.
29. Johansson C. Mobility in context: Principles of patient care skills. In: Chinworth SA, ed. Philadelphia, PA: F.A. Davis; 2012.
30. Rockefeller K. Using technology to promote safe patient handling and rehabilitation. Rehabil Nurs. 2008;33:3–9.
31. Yassi A, Cooper JE, Tate RB, et al. A randomized controlled trial to prevent patient lift and transfer injuries of health care workers. Spine (Phila Pa 1976). 2001;26:1739–1746.
32. Olkowski BF, Stolfi AM. Safe patient handling perceptions and practices: A survey of acute care physical therapists. Phys Ther. 2014;94:682–695.
33. Arnold M, Radawiec S, Campo M, Wright LR. Changes in functional independence measure ratings associated with a safe patient handling and movement program. Rehabil Nurs. 2011;36:138–144.
34. American Physical Therapy Association. The Role of Physical Therapy in Safe Patient Handling. Vol HOD P06-12-21-20. Alexandria, VA: American Physical Therapy Association; 2012.
35. Perlow E, Tunney N, Lucado A. Integrating safe patient handling into physical therapist education: Reducing the incidence of physical therapist injury and improving patient outcomes. J Phys Ther Educ. 2016;30:32–37.
36. Menzel NN, Hughes NL, Waters T, Shores LS, Nelson A. Preventing musculoskeletal disorders in nurses: A safe patient handling curriculum module for nursing schools. Nurse Educ. 2007;32:130–135.
37. Powell-Cope G, Hughes NL, Sedlak C, Nelson A. Faculty perceptions of implementing an evidence-based safe patient handling nursing curriculum module. Online J Issues Nurs. 2008;13:13p.
38. Manojlovisch M. Promoting nurses' self-efficacy: A leadership strategy to improve practice. J Nurs Admin 2005;35:271–278.
39. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986.
40. Zimmerman B. Self-efficacy: An essential motive to learn. Contemp Educ Psychol. 2000;25:82–91.
41. American Physical Therapy Association. A Normative Model of Physical Therapist Education. Alexandria, VA: American Physical Therapy Association; 2004.
42. American Physical Therapy Association. Code of Ethics for the Physical Therapist. 2013. http://www.apta.org/uploadedfiles/aptaorg/about_us/policies/hod/ethics/codeofethics.pdf. Accessed March 20, 2016.
43. American Physical Therapy Assocation. Vision statement. Alexandria, VA. http://www.apta.org/Vision/. Accessed April 15, 2016.
44. American Physical Therapy Association. Description of Physical Therapist Practice in Guide to Physical Therapist Practice. Alexandria, VA. http://www.apta.org/Guide/. Accessed April 15, 2016.
45. Commission on Accreditation in Physical Therapy Education. Evaluative criteria for accreditation of education programs for the preparation of physical therapists. 2014. http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/EvaluativeCriteria_PT.pdf. Accessed March 12, 2016.
    46. Bandura A. Perceived self-efficacy in cognitive development and functioning. Educ Psychol. 1993;28:117–148.
    47. Waters TR. When is it safe to manually lift a patient? The revised NIOSH lifting equation provides support for recommended weight limits. AJN. 2007;107:53–58.
    Keywords:

    Curriculum; Safety; Safe patient and handling mobility; DPT education

    Supplemental Digital Content

    Back to Top | Article Outline
    Copyright 2019 © Academy of Physical Theraphy Education