Background: Interprofessional education is required to develop entry-level doctorate physical therapists who are immediately ready for collaborative practice and who can deliver quality, patient-centered care. Insight into student perceptions of interprofessional experiences in clinical settings will inform pedagogical strategies for classroom/clinical education and assist in the application of core competencies. This convergent parallel mixed-method study explored the behaviors, beliefs and attitudes of first year physical therapy students toward interprofessional experiences during clinical clerkships.

Methods/Methodology: Using the Interprofessional Socializing and Valuing Scale (ISVS) (n=33), we measured the degree to which transformative learning took place following an 8-week clinical rotation, as evidenced by self-report changed behaviors, beliefs and attitudes. After subjects completed their clinical rotation in either an acute care or outpatient facility, we conducted semi-structured interviews (n=26). We used a general inductive approach and thematic content analysis to understand students' perceptions of learning outcomes and impact of interprofessional experiences in the clinical setting.

Results: A repeated measures ANOVA showed no statistical differences (p<0.05) between pre- and post-test scores within or between groups using the ISVS scale. However, thematic content analysis of the qualitative data revealed that learners perceived interprofessional experiences to be beneficial in helping them understand the importance of: establishing trusting relationships, developing practice reflexivity and good communication. Additionally students reported that these learning outcomes assisted them in: developing their professional identity, understanding the "whole" patient and recognizing the need for referral practice. The context and nature of the interprofessional experiences can be categorized as four forms of interprofessional work (networking, coordination, collaboration and team-based work).

Conclusions: Acute care clinical settings offered the most diverse and frequent opportunities for interprofessional experiences. Understanding the four forms of interprofessional work as described by students during their clinical clerkships, may assist students' in recognizing and valuing interprofessional experiences. Additionally faculty development around the forms of IP work may assist in the creation of learning objectives and assessment tools for a more evidenced-based clinical education framework within physical therapy.

BACKGROUND: Breast-cancer-related lymphedema affects ~25% of the 2 million breast cancer survivors in the US and may impact function and quality of life. PURPOSE: 1) To compare upper extremity (UE) function between women with and without lymphedema after breast cancer treatment; 2) To determine the impact of impairments on arm function and quality of life (QOL). SUBJECTS: 144 women post breast cancer treatment, 73 diagnosed with lymphedema. METHODS/MATERIALS: Demographic, symptom, Disability of Arm-Shoulder-Hand (DASH), and QOL questionnaires were completed. Objective measures included Purdue pegboard, finger tapper, Semmes-Weinstein monofilaments, vibration perception threshold, strength, range of motion (ROM), and volume. ANALYSIS: T-tests, Mann-Whitney ranked sum analysis, and chi square for significance of differences between groups were performed. Analysis-of-variance was carried out for within and between group comparisons. Linear regression was used to assess the contribution of variables to the variance in DASH and QOL scores. RESULTS: Women with lymphedema had more lymph nodes removed (p < .001), more frequent reports of UE symptoms (p< .001), higher BMI (p =.041), and higher DASH scores (greater disability) (p < .001). There were no differences in QOL scores between groups. For all participants there was less strength (elbow flexion, wrist flexion, grip), less shoulder ROM (abduction, flexion, ER), decreased sensation at the medial upper arm, and greater volume in the affected arm (p < .05). The differences between sides were greater in the women with lymphedema, particularly in shoulder abduction ROM. (p < .05). Women with lymphedema had bilaterally less elbow flexion strength and shoulder ROM (flexion, abduction, ER) (p < .05). Variables found to significantly contribute to the variance of the DASH scores were past diagnosis of lymphedema, affected UE grip strength, affected UE shoulder abduction ROM, and number of comorbidities (R 0.681, R2 of 0.463, p < .001). Age and number of comorbidities explained 33% of the variance in the QOL total score. Affected UE summed strength score contributed to the variance in 3 QOL subscale scores: physical (16%), psychological (8%), and social (11%). CONCLUSIONS: Women with lymphedema have greater UE impairment than women without, which negatively impacts arm function.

Abstract: Studies investigating the relationship between physical activity and sleep have mostly been cross-sectional, inconclusive, and use subjective means of physical activity and sleep data. This longitudinal prospective study, using a hip accelerometer, investigates how increasing daytime moderate-vigorous physical activity along with a decrease in sedentary behavior affect children's sleep. Methods: In the first study, the hip worn accelerometer was validated to the wrist worn accelerometer in measuring sleep. In a second study, fifth grade children (n=100) participating in after school activity programs located in San Francisco, CA wore an accelerometer on the hip for 3 weekdays and parents filled out a parental assessment of child's sleep. Bedtime and final wake time were ascertained by researcher estimate. Total sleep time (TST) was calculated from each unit using Sadeh's scoring routine for children's sleep. Primary analysis used Pearson's correlations for associations between the physical activity measures and TST. The association between obesity and the physical activity/sleep relationship was explored using multivariate linear regression. Results: Mean weekday MVPA significantly increased by 1.1% (2.3%) (p=0.0001), mean weekday sedentary activity significantly decreased by 2.6% (6.0%) (p=0.0001) and mean weekday TST decreased by 16 min (43.3) (p=0.0006). Correlations for the association of the difference in MVPA and difference in sedentary activity with the difference in TST were r = 0.01 and r = -0.05. Discussion: No association was found between increased MVPA and decreased sedentary activity and difference in TST in both the overweight and non-overweight. Further longitudinal studies, with larger increases in MVPA, are needed to investigate the relationship of MVPA and sleep duration and behavior.

Background: Type 2 Diabetes Mellitus (T2DM) and diabetic symmetrical polyneuropathy (DSP) impact multiple types of sensation including light touch, temperature, position sense and vibration perception. No study to date has examined the mechanosensitivity of peripheral nerves during limb movement in this population. Objective: The objective was to determine the unique effects T2DM and DSP have on nerve mechanosensitivity in the lower extremity. Design: This cross-sectional study included 43 people with T2DM and 20 age-matched controls without diabetes. Methods: Straight leg raise neurodynamic tests were performed with ankle plantar flexion (PF/SLR) and dorsiflexion (DF/SLR). Hip flexion range of motion (ROM), lower extremity muscle activity and symptoms were measured at rest, first onset of symptoms (P1) and maximally tolerated symptoms (P2). Results: The reduction in hip flexion ROM that ankle dorsiflexion induced at P2 was approximately 50% smaller in the T2DM group compared to the control group. Individuals in the T2DM group with signs of severe DSP had no difference in hip flexion ROM between PF/SLR and DF/SLR at P1 or P2. DF/SLR did not trigger the same global increase in protective muscle guarding and did not increase symptom intensity by the same magnitude in the T2DM group compared to the control group. Limitations: This study did not assess the effects of sex on neurodynamic assessments. Conclusions: These findings support the hypothesis that increased neural loading during DF/SLR induces protective muscle guarding, reduced hip flexion motion and increased symptom intensity in healthy individuals. The SLR to the onset of symptoms is a valid assessment tool that allows for structural differentiation and is an appropriate end point for lower extremity neurodynamic testing in healthy individuals. Our study findings call into question the appropriateness of performing SLR neurodynamic testing in people with T2DM and signs of severe DSP. Without the ability to respond to the increased neural loading associated with neurodynamic testing, this population is at potential risk for harm and the information gathered will be of questionable clinical value.

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