Background and Purpose. The purpose of this article is to illustrate how confirmatory factor analysis can be used to extend and clarify a researcher's insight into a survey instrument beyond that afforded through the typical exploratory factor analytic approach. The authors use as an example a survey instrument developed to measure individual differences in professional role orientation among physical therapists, the Professional Role Orientation Inventory for Physical Therapists (PROI-PT). Sample. Five hundred three physical therapists responded to a mail survey instrument that was sent to a random sample of 2,000 American Physical Therapy Association members. Methods. An adapted version of the Professional Role Orientation Inventory, a 40-item Likert-scale instrument developed to assess professional role orientation on 4 dimensions (authority, responsibility, agency, and autonomy), was used. Exploratory and confirmatory factor analyses were used to examine the factorial validity of the PROI-PT. Results. Exploratory factor analysis served as a starting point for examining the factor structure of the instrument. Confirmatory factor analysis then was used to test the hypothesized factor structure and to suggest refinements to the PROI-PT that would improve a psychometric property (internal consistency). Discussion and Conclusion. Although further refinement of the PROI-PT is needed, an instrument that yields valid and reliable measurements of individual differences in professionalism among physical therapists could further our understanding of the psychosocial aspects of physical therapist practice. Exploratory and confirmatory factor analyses can be used by researchers who study various psychosocial constructs in physical therapy.

No abstract

This is the second of 2 companion articles in this issue. The first article explored the clinical and ethical implications of new emphases in physical therapy codes of conduct reflecting the growing evidence regarding the importance of social determinants of health, epidemiological trends for health service delivery, and the enhanced participation of physical therapists in shaping health care reform in a number of international contexts. The first article was theoretically oriented and proposed that a re-thinking of ethical frameworks expressed in codes of ethics could both inform and underpin practical strategies for working in primary health care. A review of the ethical principle of "justice," which, arguably, remains the least consensually understood and developed principle in the ethics literature of physical therapy, was provided, and a more recent perspective-the capability approach to justice-was discussed. The current article proposes a clinical and ethical decision-making framework, the ethical reasoning bridge (ER bridge), which can be used to assist physical therapy practitioners to: (1) understand and implement the capability approach to justice at a clinical level; (2) reflect on and evaluate both the fairness and influence of beliefs, perspectives, and context affecting health and disability through a process of "wide reflective equilibrium" and assist patients to do this as well; and (3) nurture the development of moral agency, in partnership with patients, through a transformative learning process manifest in a mutual "crossing" and "re-crossing" of the ER bridge. It is proposed that the development and exercise of moral agency represent an enacted justice that is the result of a shared reasoning and learning experience on the part of both therapists and patients.

Objective: No peer-reviewed research has explored professional and ethical issues encountered by physical therapists in treating patients with COVID-19. The purpose of this study was to explore the experiences of physical therapists regarding the professional and ethical issues they encountered during the COVID-19 pandemic. Methods: The current study used reflexive thematic analysis, a qualitative research design developed by Braun and Clarke, to analyze individual interviews. Results: Analysis of the coded interviews produced 6 primary themes (uncertainty, physical therapist’s role, ethical dilemmas and moral distress, emotions, providing care and working conditions, and management and leadership influence) and associated subthemes. Conclusions: Physical therapists reported numerous professional and ethical issues across the individual, organizational, and societal realms during the COVID-19 pandemic. This study highlights the need for education and resources to prepare physical therapists for professional and ethical issues encountered during pandemics. Specifically, there is a need to define the physical therapist’s role in pandemics and prepare the physical therapy personnel for dealing with ethical issues, stress, uncertainty, and organizational changes associated with pandemics. Ethical guidelines would support organizations in delineating fair processes for triage and allocation of scarce resources for acute care physical therapy during healthcare emergencies. Impact: The COVID-19 pandemic has produced significant changes in healthcare and physical therapist practice. This study reports results of the first research study focusing on professional and ethical issues experienced by physical therapists in acute care during the COVID-19 pandemic. As the US faces an unprecedented spike in COVID-19 cases and deaths, results of this study may contribute to physical therapists’ preparation for and response to professional and ethical issues encountered in acute care during the pandemic.

Background and Purpose. Purtilo, Guccione, and others have noted that increased clinical autonomy for physical therapists presents more complex ethical dilemmas. The body of literature examining physical therapy ethics, however, is relatively small and has not been analyzed. The primary purposes of this research were: (1) to use multiple perspectives to describe and analyze literature examining ethics in physical therapy from 1970 to 2000, (2) to develop a model to describe the evolution of knowledge of ethics in physical therapy during this period, and (3) to compare the proposed model with the evolutionary models proposed by Purtilo in physical therapy and by Pellegrino in bioethics. Sample. The sample consisted of peer-reviewed journal articles cited in the MEDLINE or Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases between 1970 and 2000 or referenced in Ethics in Physical Therapy. Methods. A two-phase mixed quantitative and qualitative method was used to analyze publications. In the quantitative phase, the author sorted publications into a priori categories, including approach to ethics, author, decade, country of publication, role of the physical therapist, and component of morality. During the qualitative phase of the research, the author analyzed and sorted the publications to identify common themes, patterns, similarities, and evolutionary trends. These findings were compared with the evolutionary models of Pellegrino and Purtilo. Results. The 90 publications meeting inclusion criteria were predominantly philosophical, using the “principles” perspective; focused on the patient/client management role of the physical therapist; and addressed the moral judgment component of moral behavior. As predicted by Purtilo's model, the focus of identity evolved from self-identity to patient-focused identity, with increasing representation of societal identity. Recurrent themes included the need to further identify and clarify physical therapists' ethical dilemmas, the interrelationship between clinical and ethical decision making, and the changing relationship with patients. Discussion and Conclusion. Although knowledge of ethics grew steadily between 1970 and 2000, this retrospective analysis identified gaps in our current knowledge. Further research is needed to address the unique ethical problems commonly encountered in all 5 roles of the physical therapist; patient perspectives on ethical issues in physical therapy; variety in ethical approaches; factors affecting moral judgment, sensitivity, motivation, and courage; and cultural dimensions of ethical practice in physical therapy.

No abstract

Recent revisions of physical therapy codes of ethics have included a new emphasis concerning health inequities and social injustice. This emphasis reflects the growing evidence regarding the importance of social determinants of health, epidemiological trends for health service delivery, and the enhanced participation of physical therapists in shaping health care reform in a number of international contexts. This perspective article suggests that there is a "disconnect" between the societal obligations and aspirations expressed in the revised codes and the individualist ethical frameworks that predominantly underpin them. Primary health care is an approach to health care arising from an understanding of the nexus between health and social disadvantage that considers the health needs of patients as expressive of the health needs of the communities of which they are members. It is proposed that re-thinking ethical frameworks expressed in codes of ethics can both inform and underpin practical strategies for working in primary health care. This perspective article provides a new focus on the ethical principle of justice: the ethical principle that arguably remains the least consensually understood and developed in the ethics literature of physical therapy. A relatively recent theory of justice known as the "capability approach to justice" is discussed, along with its potential to assist physical therapy practitioners to further develop moral agency in order to address situations of health inequity and social injustice in clinical practice.

No abstract