Several MGH Institute faculty members have been involved in two task forces for the Academy of Neurologic Physical Therapy (ANPT) section of the American Physical Therapy Association (APTA). Laura Plummer, PT, DPT, EdD, dean of the School of Health and Rehabilitation Sciences, spoke to OSC’s Lisa McEvoy about research findings that were presented at the APTA Combined Sections Meeting (CSM) held in Houston from March 13-15, from the ANPT Movement Analysis and Balance Task Forces.
How did you become involved in this research?
There is historical context to this research. In 2013, the American Physical Therapy Association created APTA Vision 2020, a strategic vision of “transforming society by optimizing movement to improve the human experience.” The vision had six elements to achieve by 2020: direct access, evidence-based practice, professionalism, doctoring profession, autonomous practice, and practitioner of choice. To achieve this vision of transforming society by optimizing movement to promote health and wellness, mitigate impairment, and prevent disability, the physical therapy profession needed to establish that we were experts in movement.
As a first step of this work, in 2015, the definition of the Movement System as the foundation for optimizing movement to improve the health of society was adopted by the APTA, and in 2016 a movement system summit developed an action plan to integrate the movement system into practice, education, leadership, and advocacy and to develop diagnostic criteria that reflect the physical therapist’s ability to effectively manage disorders of the movement systems. To answer this call, the Academy of Neurologic Physical Therapy, of which I am a member, formed two subgroups to standardize movement analysis and develop diagnoses for balance dysfunction. I was appointed to the diagnosis for the balance sub-group, but the two groups worked in parallel.
What has the task force done?
The original task forces embarked on an iterative process to standardize movement analysis and develop diagnoses for balance dysfunction. Both groups worked separately and collaboratively to develop and integrate a framework for movement analysis and a diagnostic process and balance diagnoses. Over the years, the two subgroups of the task force presented the work and utilized feedback to update and refine the frameworks. In 2021, the subgroups published two papers, Framework for Movement Analysis and Movement System Diagnosis for Balance Dysfunction. Dr Kathleen Gill-Body, adjunct faculty in the Doctor of Physical Therapy program, was the first author for the diagnosis of balance dysfunction manuscript. We continued to present nationally on the work of the subgroups and received positive and constructive feedback, which led us to our current research to further refine the framework for movement analysis and diagnostic process and balance diagnoses. We conducted a pilot study with clinicians that led to revisions in how to analyze movement, a universal framework for the movement analysis of any tasks, new diagnoses, a refined diagnostic process, and updated evidence for task-based interventions. From this work, the subgroups have two additional manuscripts under review based on this pilot study.
It can take a long time for knowledge creation in research to be shared and applied in practice. In 2023, the Academy of Neurologic Physical Therapy developed two knowledge translation (KT) task forces to create resources to bring this work to clinical practice. Dr. Anne McCarthy Jacobson, assistant professor in the DPT program, is the co-chair of the Movement Analysis KT Task Force, and Dr. Ana Sanchez Junkin, DPT alum and adjunct faculty in the DPT program, is a member of the Balance Diagnosis KT task force. While we were working on the updates to the original work, the KT groups were collaborating with us to create resources for clinicians that incorporated the refinements from the research.
Why was this work necessary?
To advance the APTA vision of transforming society by optimizing movement to improve the human experience, physical therapists must demonstrate that they are autonomous, evidence-based practitioners who provide quality, cost-effective care. As such, we need to demonstrate that we have consistent practice behaviors and a body of evidence to support what we do. To advance this goal, we need to reduce unwanted variation in practice not explained by patient preference or disease severity. Without movement system diagnoses, PT practice and research are often classified based on medical diagnoses. However, individuals with the same medical diagnoses (e.g. Multiple Sclerosis) may have different movement problems that warrant different interventions. This can result in research trials based on medical diagnoses with responders and non-responders resulting in difficulty interpreting the best interventions. Through the development of movement diagnoses, we hope to create a more standardized language among PTs and to improve research demonstrating effectiveness for different movement diagnoses.
What did the presentation entail at the APTA Combined Sections Meeting?
Collaborators from the ANPT Movement Analysis and Balance Task Forces presented the results from the recent research studies and introduced the newly developed KT resources to help translate the research into practice. The presentation focused first on the updates by two of the original task force members, Dr. Lois Hedman and Dr. Christine Tyrell, and then Dr. Chrissy Zimmerman and Dr. Ana Sanchez Junkin led participants through case-based application of the frameworks utilizing the newly created KT resources.
A large group attended the presentation and provided really positive feedback while generating more interest in the work. This work will provide educators and clinicians with tools to incorporate standardized movement analysis and movement system balance diagnoses into their practice and also advance future work in creating additional movement-based diagnoses. Our next step is to conduct reliability and validity studies of the framework for movement analysis and balance diagnoses while also working on developing other diagnoses for movement dysfunction (e.g. locomotor dysfunction).
How will this work impact the physical therapy curriculum at the Institute?
We already have incorporated movement analysis of tasks and the diagnostic process into the integrated PT curriculum. Using case-based application throughout the curriculum, students in the DPT program utilize the framework for movement analysis and develop clinical reasoning skills to establish diagnosis and/or classification of movement dysfunction. I presented with other collaborators at CSM in Boston last year on incorporating the movement system work into physical therapist education. The refinement of this work and the development of the KT resources will be beneficial in further incorporating movement analysis and movement diagnoses into PT education at the IHP in beyond.
There is still much work to be done, especially in the area of movement diagnosis, and I look forward to the research and debate in the field of physical therapy that will continue to advance the profession.
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