SummaryBackground: Achilles tendon structural changes are common after injury and correlate with recovery of function. Having simple, inexpensive, yet valid and reliable measures of Achilles tendon structure are useful both in research and clinical. The purpose of this study was to perform reliability and validity measures of extended field of view (EFOV) ultrasound (US) imaging of the Achilles tendon. Methods: eight cadavers (16 tendons) were used for the validation study to compare Achilles tendon length measurements from US images with actual measured length from dissected tendons. Nine healthy subjects (18 tendons) were included in the test-retest evaluation. Results: the correlation between the US images and cadaveric measurements was excellent (ICC=0.895) for the length between calcaneus and the gastrocnemius and good (ICC=0.744) for the length between the calcaneus and the soleus. The between-limb reliability was excellent (ICC 0.886-0.940) for the tendon length measurements with standard error of measurements (SEM) of 0.64 cm for calcaneus to soleus and 0.67 cm for calcaneus to gastrocnemius. Between-day test-retest reliability was also excellent (ICC=0.898-0.944). Conclusion: this study supports the use of EFOV US imaging as a reliable and valid method to determine Achilles tendon length and thickness, and using the uninjured limb for comparison.

Background: Working with individuals with cognitive impairment can be an uncomfortable experience for students in the health professions. Using a one-time clinical experience to expose them to this population is a common strategy used to increase comfort and improve skills. Unfortunately, relying on outside facilities to provide this experience introduces variability that can negatively affect outcomes. Objective: The purpose of this study was to compare the outcomes associated with a standardized patient (SP) encounter with a one-time clinical education experience in order to determine the optimal learning opportunity for students. Methods: Eighty-two DPT students participated in a session where they practiced communication skills and assessment procedures on individuals simulating cognitive impairment. Each group of students performed a brief interview with the SP, administered the Mini-Cog test to screen for cognitive impairment, and completed two performance-based functional outcome measures common in physical therapy. At the completion of the session the SPs stepped out of character and gave the student groups verbal feedback about their performance. Feedback was focused on student communication skills and ability to provide clear instructions while adapting to changes in the SP's cognition. Results: In order to assess the overall effectiveness of the SP experience, we compared learning outcomes with the one-time clinical experience. The total number of students participating in one of these experiences between 2016 and 2018 was 219. A strong positive trend of improvement is seen between each of the years and between the clinical site and standardized patient experiences. The ability to perform cognitive tests was considerably higher with the SPs than the clinical experiences. Chi-square tests of independence were used to compare students who reported achieving each of the goals of the activity and those who did not across each of the years. Significant relationships were found between achievement of outcomes and the year of participation and type of experience for all five outcomes reported. Effect size surpassed Cohen's definition of "small" (Cramer's V ≥ 0.1) for all five outcomes. Effect size was largest for "performed cognitive tests," with 2 (2, N=219)=74.24, p<0.00001 and =0.58. Student comments regarding each of the experiences was analyzed and compared using qualitative methods. Unique to 2018, was the emergence of the word "feedback." The opportunity to receive feedback was cited in 31 comments in the 2018 SP encounter. Other words emerging in 2018 include "real," "realistic," "convincing," and "accurate". Conclusion: Overall, there was high level of agreement among the students that the SP experience helped them recognize cognitive impairment and communicate with individuals with cognitive impairment. Students strongly agreed that the SP portrayal was realistic and that the feedback they provided was valuable to their learning. When comparing the SP encounter to the one-time clinical experience, f...

Several professional organizations have called for increased preparation of health professionals capable of working with older adults, including those with cognitive impairment. Standardized patients (SP) are often used in interprofessional education (IPE) in the health professions, but limited data exists to support their use when teaching about the care and management of older adults with cognitive impairment. The purposes of this project were to: 1) develop, implement, and assess an interprofessional standardized patient exercise involving physical and occupational therapy students and 2) to evaluate students’ perceptions of a SP encounter on relevance and utility to patients with cognitive impairment. 88 students representing physical therapy (DPT) and occupational therapy (DrOT) were assigned to interprofessional teams to evaluate an SP portraying an older adult with cognitive impairment. At the conclusion of the session the SP provided the group formative feedback. Student teams then completed an assignment to develop a collaborative intervention plan and addressed questions about roles and responsibilities and communication/teamwork. Pre-/post- surveys focusing on the knowledge of roles and responsibilities, communication, and teamwork were completed by all students. Students also completed an evaluation about the SP experience. Results demonstrated student agreement to understanding the role of the other’s profession improved 28.67%; being comfortable communicating with the geriatric population improved 27.31%; and working in interprofessional teams can improve geriatric patient care improved 32.11%. These findings demonstrate that use of SPs has several advantages in teaching students how to work and communicate with individuals with cognitive impairments as an interprofessional team.