Background/Statement of Need
Upon admission to physical therapy school, I was never a personal trainer or physical therapy tech, and I had close to the minimum number of shadow hours required. If not for growing up playing sports, I would have been drastically sheltered from therapeutic exercise interventions. Despite a history of spending time in the weight room for sports, I was ill-prepared to prescribe and modify exercises on my first orthopedic rotation. Google and previous patient notes were my friend on that rotation. Though it is not necessary to use unique exercises for every patient, it was difficult to devise specialized treatments to each patient, especially when a certain movement was too difficult. The curriculum at UNC provides examples of interventions scattered throughout lectures along with an exercise prescription class, but students could benefit from expanded education on specific interventions, how to progress and regress them to fit the needs of a patient, and how to apply clinical reasoning to select exercises for a certain deficit or pathology. Anecdotally, many third and second years have expressed interest in a resource that would address these topics. This resource has the capability to improve patient care when on clinical rotations and provide an opportunity to initiate more comprehensive clinical reasoning.
Purpose
- Understand how and when to progress and regress shoulder exercises
- Improve competence and confidence when treating shoulder pathologies
- Incite clinical reasoning and problem solving
- Serve as a quick and easy reference in the clinic when approaching patients with shoulder impairments
- Provide an introduction to understanding exercise prescription and modification
Products
The products of the project are intended for 1st and 2nd year DPT students beginning orthopedic clinical experiences. The chart includes shoulder exercise prescriptions with photos, cues, progressions, and regressions.
Therapeutic Exercise for Muscular Deficits of the Shoulder Chart
Therapeutic Exercise for Muscular Deficits of the Shoulder Evidence Table
Evaluation Component
Evaluation of capstone materials was provided by DPT students currently on their first orthopedic rotation. After reviewing the products, the students completed the following survey analyzing the utility and efficacy of the project:
https://forms.gle/PMjUMSLdyF1JcHmh6
Peer/Self-Assessment
The project was reviewed and evaluated by nine 1st and 2nd year DPT students using the link above. Overall, the common consensus was that the resource was helpful and effective. 100% of reviewers rated the chart as helpful or very helpful in improving understanding of how to progress and regress exercises. 100% of the reviewers also stated that the chart was effective or very effective in providing an introduction to understanding exercise prescription and modification. About 90% of the students rated the project as helpful or very helpful in improving their confidence in treating shoulder pathologies with therapeutic exercise. Also, 90% of the students reported that they were likely or very likely to reference this resource when treating patients in the outpatient setting.
The students also provided feedback on how to improve the resource for DPT students. Some suggestions were to include a flow chart deciphering when to progress/regress exercises for specific pathologies, manual therapy techniques and clinical pearls for the shoulder, exercise videos, and increased variety of exercises (closed-chain/dynamic). One reviewer expressed interest in including a presentation specifically for exercises in a class. The reviewers specifically appreciated the compensations and accessory movement sections.
Upon personal reflection and my own perception of utility, the chart would be more effective and useful if it were to involve more functional exercises, videos, and increased explanations of how to identify the need for progression/regression. I believe the chart was efficacious in providing an introduction to clinical decision making regarding how to progress and regress exercise interventions for the shoulder. The chart is the most useful for DPT students initially entering orthopedic clinical rotations and may not have as much utility for more experienced students. For future projects, an interesting idea could be to create a video exercise library posted to a UNC DPT YouTube channel.
Self Reflection
Throughout the process of working on this capstone, I have grown as a clinician, teacher, and student. Researching various aspects of shoulder intervention and synthesizing the information has improved my ability to adapt treatment to the patient in front of me. Through the process of information consolidation, I attempted to put myself in the shoes of a student who has not learned about or experienced exercise progression/regression. In turn, I believe I have developed more of an understanding of how to educate and teach others. As for my own position as a student, I have been reminded of the humility that is necessary as a physical therapist because I will forever be learning as I practice. Not only did I learn from the research I reviewed, but the contributors listed below instilled an aspiration within me to continue to learn and improve my knowledge and skills as a physical therapist.
Acknowledgments
I want to express my sincerest gratitude to Jennifer Cooke, Jeff O’Laughlin, Dylan Michel, and Jessica Cassidy for taking time out of their schedules to provide their wisdom, knowledge, and guidance in the creation of this project. These four sages in the realm of physical therapy were integral in improving my own understanding of exercise prescription and patient care. I also want to acknowledge the 1st and 2nd year DPT students that provided feedback on this project. Your feedback will help shape future projects to come and assist in developing future physical therapists. I appreciate you all!