Objective The purpose of this study was to examine the safety and efficacy of a high-intensity progressive rehabilitation protocol (HI) beginning 4 days after total knee arthroplasty (TKA) compared to a low-intensity (LI) rehabilitation protocol. Methods One hundred sixty-two participants (aged 63±7 years; 89 females) were randomized to either the HI group or LI group after TKA. Key components of the HI intervention were the utilization of progressive resistance exercises and a rapid progression to weight-bearing exercises and activities. Both groups were treated in an outpatient setting 2-3 times per week for 11 weeks (26 total sessions). Outcomes included the stair climbing test (SCT) (primary outcome), timed-up-and-go (TUG) test, 6-minute walk (6MW) test, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form 12 (SF-12), knee ROM, quadriceps and hamstring strength, and quadriceps activation. Outcomes were assessed preoperatively and at 1, 2, 3 (primary end point), 6, and 12 months postoperatively. Results There were no significant differences between groups at 3 or 12 months in SCT, TUG, 6MW, WOMAC scores, knee ROM, quadriceps and hamstrings strength, quadriceps activation, or adverse event rates. By 12 months, outcomes on the 6MW, TUG, WOMAC, SF-12, quadriceps and hamstring strength, and quadriceps activation had improved beyond baseline performance in both groups. Conclusion Both the HI and LI interventions were effective in improving strength and function after TKA. High-intensity progressive rehabilitation is safe for individuals after TKA. However, its effectiveness may be limited by arthrogenic muscular inhibition in the early postoperative period.

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Introduction/Review of Literature: Medical error is inevitable due to complex environments and human fallibility. Other professions have published extensively on error reduction and students as a contributing aspect of clinical error. The physical therapy profession has lagged behind. Purpose: To explore doctor of physical therapy (DPT) student experiences with patient safety during clinical education, including factors that could potentially contribute to error. Subjects: Seventy DPT students at the University of Colorado. Methods: Sequential explanatory mixed methods design including quantitative (survey) and qualitative (focus group) data collection. Results and Conclusion: Ninety-one percent of students participated in the survey, and 13% in the focus groups. Five themes were identified, including 1) Facility safety culture, 2) Communication methods and frequency, 3) Widespread clinical education/clinical instructor variability, 4) Dual identity as student and clinician, and 5) Student stress. These themes all have the potential to increase patient safety risk. Discussion and Conclusion: Some issues identified in this paper are specific to students and need to be addressed at the clinical education level but with a focus on patient safety risk. However, many of the issues were related to the broader system and clinical environment and may have occurred without the student present. There are many opportunities for better academic and clinical partnerships with dual goals of improving educational excellence and reducing patient safety risk.

Poor performance on the quadriceps activation battery early after TKA is related to poor quadriceps activation and poor recovery in the early postoperative period. Patients in the low quadriceps activation battery group took 3 months to recover to the same level as the high quadriceps activation battery group. The quadriceps activation battery may be useful in identifying individuals who need specific interventions to target activation deficits or different care pathways in the early postoperative period to speed recovery after TKA.

Objective The purpose of this study was to systematically review the literature regarding teaching quality improvement (QI) in physical therapist education based on the Institute of Medicine’s 6-element definition of QI. Educational activities in QI methods in physical therapist professional education curricula, their developmental stage, and their level of evaluation were described. Methods Keywords related to physical therapist students and QI educational activities were used to search studies indexed in PubMed, CINAHL, and ERIC published from 2004 through November 2020. This search yielded 118 studies. After applying inclusion and exclusion criteria, 13 studies were retained for full-text review, which was conducted independently by 2 reviewers. The University of Toronto framework was used to assess developmental stage, and Kirkpatrick’s taxonomy was used to assess the evaluation level of 4 retained studies. Results The scope of QI educational activities in the 4 retained studies was limited to 3 of the 6 elements of QI: identifying opportunities for improvement, designing and testing interventions, and identifying errors and hazards in care. None of the studies included educational activities to teach understanding and measuring quality of care. Three of the 4 studies spanned the first 2 stages of the University of Toronto framework (exposure and immersion); 1 study was limited to exposure. None of the studies assessed competence in QI methods. Evaluation of QI education was limited to Kirkpatrick levels 1 (reaction) or 2 (learning). None of the studies evaluated activities at level 3 (transfer of new behaviors) or level 4 (results). Conclusion Education in QI methods in professional physical therapist curricula may be limited in scope due to constraints in physical therapist education and the strategic objective of the profession to differentiate itself from other professions. Impact Entry-level physical therapists might not be educated to fully participate in interprofessional teams that use QI methods to continuously improve the quality of patient-centered care.