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Full-Text Articles in Rehabilitation and Therapy

Pre- Versus Post-Exercise Protein Intake Has Similar Effects On Muscular Adaptations, Brad J. Schoenfeld, Alan A. Aragon, Colin Wilborn, Stacie L. Urbina, Sara E. Hayward, James Kriegor Jan 2017

Pre- Versus Post-Exercise Protein Intake Has Similar Effects On Muscular Adaptations, Brad J. Schoenfeld, Alan A. Aragon, Colin Wilborn, Stacie L. Urbina, Sara E. Hayward, James Kriegor

Publications and Research

The purpose of this study was to test the anabolic window theory by investigating muscle strength, hypertrophy, and body composition changes in response to an equal dose of protein consumed either immediately pre- versus post-resistance training (RT) in trained men. Subjects were 21 resistance-trained men (>1 year RT experience) recruited from a university population. After baseline testing, participants were randomly assigned to 1 of 2 experimental groups: a group that consumed a supplement containing 25 g protein and 1 g carbohydrate immediately prior to exercise (PRE-SUPP) (nD9) or a group that consumed the same supplement immediately post-exercise (POST- SUPP) …


The Reciprocal Relationship Between Art And Occupational Therapy Practice, Jennifer Fortuna Jan 2017

The Reciprocal Relationship Between Art And Occupational Therapy Practice, Jennifer Fortuna

The Open Journal of Occupational Therapy

Susan Burwash, Ph.D., OTR/L, an occupational therapy professor and artist based in Washington State, provided the cover art for the Winter 2017 issue of the Open Journal of Occupational Therapy (OJOT). The featured piece contains Professor Burwash’s signature fauxpals, lampwork glass beads made from molten glass and pure silver foil. Art creates balance between traditional medicine and personal medicine, those meaningful activities that give life purpose. Professor Burwash’s personal medicine is making beautiful things that can be given away.


Changes In Knowledge, Skills, And Confidence In Fieldwork Educators After An Evidence-Based Practice Short Course, Alison Nichols Jan 2017

Changes In Knowledge, Skills, And Confidence In Fieldwork Educators After An Evidence-Based Practice Short Course, Alison Nichols

The Open Journal of Occupational Therapy

Background: It is critical that fieldwork educators demonstrate effective use of evidence for clinical decision making so that occupational therapy (OT) students learn to apply concepts from the classroom to everyday practice.

Method: OT fieldwork educators completed a 3-hour short course designed to provide instruction on the first three steps of the evidence-based practice (EBP) process: developing a clinical question, searching the literature, and assessing the evidence. The participants completed a pretest on site and posttest 3 weeks after the course to assess their knowledge, skills, and confidence when using EBP. The Adapted Fresno Test was used to …


Generation Y Health Professional Students’ Preferred Teaching And Learning Approaches: A Systematic Review, Caroline Mary Hills, Tracy Levett-Jones, Samuel Lapkin, Helen Warren-Forward Jan 2017

Generation Y Health Professional Students’ Preferred Teaching And Learning Approaches: A Systematic Review, Caroline Mary Hills, Tracy Levett-Jones, Samuel Lapkin, Helen Warren-Forward

The Open Journal of Occupational Therapy

Generation Y or Millennials are descriptors for those born between 1982 and 2000. This cohort has grown up in the digital age and is purported to have different learning preferences from previous generations. Students are important stakeholders in identifying their preferred teaching and learning approaches in health professional programs. This study aimed to identify, appraise, and synthesize the best available evidence regarding the teaching and learning preferences of Generation Y health professional students. The review considered any objectively measured or self-reported outcomes of teaching and learning reported from Generation Y health professional student perspectives. In accordance with a previously published …


International Service Learning: Occupational Therapists' Perceptions Of Their Experiences In Guatemala, Jason C. Lawson, Myrna R. Olson Jan 2017

International Service Learning: Occupational Therapists' Perceptions Of Their Experiences In Guatemala, Jason C. Lawson, Myrna R. Olson

The Open Journal of Occupational Therapy

The U.S. is fast becoming more culturally diverse, creating a greater need for entry-level occupational therapists to be culturally competent. In order to increase students’ cultural competence, there is a growing support for international service learning (ISL). The purpose of this qualitative research study was to explore the perspectives of occupational therapy practitioners who engaged in ISL as occupational therapy students. Interviews were conducted with nine practicing occupational therapists, all of whom graduated from the same occupational therapy program in the U.S. and participated in an ISL experience in Guatemala. Phenomenological methods were used to analyze the transcribed interviews for …


Using High Fidelity Simulation To Impact Occupational Therapy Student Knowledge, Comfort, And Confidence In Acute Care, Debra M. Gibbs, Mary Dietrich, Emmy Dagnan Jan 2017

Using High Fidelity Simulation To Impact Occupational Therapy Student Knowledge, Comfort, And Confidence In Acute Care, Debra M. Gibbs, Mary Dietrich, Emmy Dagnan

The Open Journal of Occupational Therapy

Background: As the demand for occupational and physical therapists in acute care settings is increasing, students are reporting a need for increased educational preparation to handle the complexities they may face in this setting. This pretest/posttest study examines the impact of an inter-professional high fidelity simulation experience on perceived levels of knowledge, comfort, and confidence among occupational therapy doctorate students when handling an acutely ill patient in an ICU setting.

Methods: Two cohorts of occupational therapy students participated in an inter-professional acute care scenario with high fidelity simulation mannequins (Cohort 1, n = 19; Cohort 2, n = …


Evaluation Of A Coaching Experiential Learning Project On Ot Student Abilities And Perceptions, Erin A. Phillips Jan 2017

Evaluation Of A Coaching Experiential Learning Project On Ot Student Abilities And Perceptions, Erin A. Phillips

The Open Journal of Occupational Therapy

Innovative teaching methods to address emerging practice needs are critical components of effective occupational therapy education. Experiential learning strategies can enhance skill development and translation of knowledge into OT clinical practice. In addition, skills such as coaching may provide important links to health promotion practices. Thirty-two occupational therapy students took part in an experiential project to connect occupational engagement and health for a community of older adults. A pretest/posttest design was used to evaluate program outcomes in student perceived abilities, and narrative reflection papers provided postexperience qualitative information. The students improved in all 10 areas of abilities self-assessment with …


Adapting To A Challenging Fieldwork: Understanding The Ingredients, Emily Raphael-Greenfield, Ivettedari Miranda-Capella, Myra Branch Jan 2017

Adapting To A Challenging Fieldwork: Understanding The Ingredients, Emily Raphael-Greenfield, Ivettedari Miranda-Capella, Myra Branch

The Open Journal of Occupational Therapy

Two occupational therapy students were assigned to an inpatient psychiatric unit for their first Level 1 fieldwork. With limited on-site supervision provided, they looked to each other for peer support and collaboration in assisting one patient with severe depression who was considered the “sickest patient on the unit.” The students were able to work together and make a positive intervention with this patient despite their novice status. Understanding what each of them brought personally to this experience as well as the nature of their working relationship and their use of concepts taught in the classroom has important implications for occupational …


Blended Approach To Occupational Performance (Baop): Guidelines Enabling Children With Autism, Jordan M. Skowronski, Jack R. Engsberg Jan 2017

Blended Approach To Occupational Performance (Baop): Guidelines Enabling Children With Autism, Jordan M. Skowronski, Jack R. Engsberg

The Open Journal of Occupational Therapy

The performance of daily activities is impacted by motor impairments in children with autism spectrum disorders (ASD). Research has recently demonstrated the prevalence and specificity of motor impairments in people with ASD. The motor learning of individuals with ASD is partially intact, and evidence suggests that a method to alter skill learning and repeated practice of motor sequences might be beneficial. Aiming to use this knowledge to guide occupational therapy interventions, initial guidelines for children with ASD blended Cognitive Orientation to daily Occupational Performance (CO-OP) with virtual reality (VR) were created. An expert panel reviewed the initial guidelines. The results …


Parental Adherence To A Research Protocol To Investigate The Effect Of The Wilbarger Therapressure Programtm: A Qualitative Study, Hugh Stewart, Kobie Boshoff, Scott Weeks Jan 2017

Parental Adherence To A Research Protocol To Investigate The Effect Of The Wilbarger Therapressure Programtm: A Qualitative Study, Hugh Stewart, Kobie Boshoff, Scott Weeks

The Open Journal of Occupational Therapy

Background: The Wilbarger Therapressure ProgramTM is a technique applied by parents at home for sensory overresponsivity in children. The program is anecdotally reported to be demanding on parents, which can affect parental adherence. Currently, there is an absence of high quality research to support the use of the program. This pilot study aimed at developing appropriate research protocols to investigate the effectiveness of the program on the stress response of children with sensory overresponsivity. This article reports on the second phase of the project.

Method: After participating in the trial data collection protocols to investigate the effect …


Perceptions Of Occupational Therapy Involvement In School Mental Health: A Pilot Study, Susan M. Cahill, Brad E. Egan Jan 2017

Perceptions Of Occupational Therapy Involvement In School Mental Health: A Pilot Study, Susan M. Cahill, Brad E. Egan

The Open Journal of Occupational Therapy

Background: Mental health providers outside of occupational therapy, including those who work in school systems practice, often do not fully understand the contribution that occupational therapy practitioners can make to the delivery of mental health services.

Method: The purpose of this mixed methods pilot study is to describe how instructional support staff from one special education cooperative learned about occupational therapy’s role in school mental health and to explain how this education changed the instructional support staff members’ perceptions regarding the involvement of occupational therapy practitioners in school-based mental health services.

Results: Instructional support staff's perceptions about …


Continuing Competence Trends Of Occupational Therapy Practitioners, Ketti Johnson Coffelt, Linda S. Gabriel Jan 2017

Continuing Competence Trends Of Occupational Therapy Practitioners, Ketti Johnson Coffelt, Linda S. Gabriel

The Open Journal of Occupational Therapy

The purpose of this pilot study was to examine the perceptions and practices of occupational therapists regarding the types of professional development activities they seek to ensure competency. A self-report survey was used to investigate the therapists’ selection of and engagement in professional learning activities. The results from 43 occupational therapists were analyzed. Descriptive results identified the value of a professional development plan and collaboration with colleagues. Self-assessment and searching for and analyzing journal articles emerged as frequently used continuing competence learning practices. The results showed that therapists actively plan and select formal and informal professional activities to promote meaningful …


Outcome Measures With Copm Of Children Using A Wilmington Robotic Exoskeleton, Tracy Shank, Marissa Eppes, Jobayer Hossain, Margaret Gunn, Tariq Rahman Jan 2017

Outcome Measures With Copm Of Children Using A Wilmington Robotic Exoskeleton, Tracy Shank, Marissa Eppes, Jobayer Hossain, Margaret Gunn, Tariq Rahman

The Open Journal of Occupational Therapy

Background: The Wilmington Robotic Exoskeleton (WREX) is a body-powered, four degrees of freedom orthosis that allows gravity-minimized movement of the arm at the shoulder and elbow. We sought to measure patient satisfaction and performance with use of the WREX during activities of daily living, play, and at school.

Method: Twenty-five families completed a phone interview based on the Canadian Occupational Performance Measure (COPM). These families all had a child, aged 2 to 21years, who had a neuromuscular disorder and who had used the WREX for at least eight months. The parents rated their child’s performance of and satisfaction …


The Role Of Occupational Therapy In Community-Based Programming: Addressing Childhood Health Promotion, Julie D. Kugel, Heather Javherian-Dysinger, Liane Hewitt Jan 2017

The Role Of Occupational Therapy In Community-Based Programming: Addressing Childhood Health Promotion, Julie D. Kugel, Heather Javherian-Dysinger, Liane Hewitt

The Open Journal of Occupational Therapy

Background: Obesity and poor health habits impact youth’s health and occupational participation. Occupational therapy’s role in preventing and treating obesity continues to emerge in the research literature. This article explores the impact of a community-based program emphasizing health and wellness for female youth.

Methods: Five girls 11 to 13 years of age participated in the healthy occupations program. Before and after the program, the participants engaged in an individual semi-structured interview and completed the Canadian Occupational Performance Measure and the CATCH Kids Club Questionnaire. The youth participated in a focus group midprogram.

Results: The participants were receptive …


State Of The Journal Year 4: Mapping Our Progress, Diane Powers Dirette Jan 2017

State Of The Journal Year 4: Mapping Our Progress, Diane Powers Dirette

The Open Journal of Occupational Therapy

No abstract provided.


Evolution Of Occupational Therapy Practice: Life History Of Kelly Taubert, M.S. Otr/L, Amber Fernandez, Hannah Fiser Jan 2017

Evolution Of Occupational Therapy Practice: Life History Of Kelly Taubert, M.S. Otr/L, Amber Fernandez, Hannah Fiser

Oral History Student Papers

This life history is one of twenty-nine life history interviews, which are a part of a larger project, Life Histories of Individuals Who Have Been Influential in Developing Occupational Therapy (OT) in North Dakota and Wyoming. The purpose of this project is to gather information about the history and evolution of occupational therapy (OT) practice in North Dakota and Wyoming through life histories of individuals who have been influential in developing OT in these two states. It is anticipated the life history process will be a powerful way to gather this information. This study is intended to provide current …


A Systems Approach To The Problem Of Falls In Old Age, Patrick A. Dillon Jan 2017

A Systems Approach To The Problem Of Falls In Old Age, Patrick A. Dillon

Theses and Dissertations--Gerontology

The problem of falls in old age is enormously costly and disruptive for the older individual, others, and society, and its severity is likely to intensify as our population ages. This dissertation takes a systems-oriented approach toward the falls problem and is presented in two parts. The first part critically develops a new approach to the problem of falls. The second part describes an empirical study that applies this new approach in a pragmatic manner.

Conventional fall prevention strategies employ a reductionist approach to the problem of falls. This approach is questioned because it corresponds poorly to the holistic nature …


Wrist-Worn Physical Activity Trackers Progressively Underestimate Steps With Increasing Walking Speeds, T. Sears, E. Alvalos, S. Lawson, I. Mcalister, C. Eschbach, J. Bunn Jan 2017

Wrist-Worn Physical Activity Trackers Progressively Underestimate Steps With Increasing Walking Speeds, T. Sears, E. Alvalos, S. Lawson, I. Mcalister, C. Eschbach, J. Bunn

Physical Therapy

No abstract provided.


Physiological And Emotional Influence On Heart Rate Recovery After Submaximal Exercise, J. Bunn, J. Manor, E. Wells, B. Catanzarito, B. Kincer, C. Eschbach Jan 2017

Physiological And Emotional Influence On Heart Rate Recovery After Submaximal Exercise, J. Bunn, J. Manor, E. Wells, B. Catanzarito, B. Kincer, C. Eschbach

Physical Therapy

No abstract provided.


The Effect Of Current Low Back Pain On Volitional Preemptive Abdominal Activation During A Loaded Forward Reach Activity, V. R. Nagar, T. L. Hooper, G. S. Dedrick, J. M. Brismee, M. K. Mcgalliard, P. S. Sizer Jan 2017

The Effect Of Current Low Back Pain On Volitional Preemptive Abdominal Activation During A Loaded Forward Reach Activity, V. R. Nagar, T. L. Hooper, G. S. Dedrick, J. M. Brismee, M. K. Mcgalliard, P. S. Sizer

Physical Therapy

No abstract provided.


Critically Appraised Paper For “The Effects Of A Home-Based Virtual Reality Rehabilitation Program On Balance Among Individuals With Parkinson’S Disease”, Amanda Lee, Sophie E. Miller, Holly Snyder, Phoebe Taasan, Kitsum Li Jan 2017

Critically Appraised Paper For “The Effects Of A Home-Based Virtual Reality Rehabilitation Program On Balance Among Individuals With Parkinson’S Disease”, Amanda Lee, Sophie E. Miller, Holly Snyder, Phoebe Taasan, Kitsum Li

Occupational Therapy | Critically Appraised Papers Series

This study evaluated the effectiveness of a 12-week home-based exercise program using the Nintendo Wii system in its capacity to improve balance and balance confidence and maintain exercise compliance. Balance and balance confidence were measured with the Center of Pressure Length (COPL) and Activities-Specific Balance Confidence Scale (ABC), which were administered before the start of the intervention, 6 weeks into the intervention, and within 1 week postintervention. Although changes in balance and balance confidence scores were found to be nonsignificant, a pattern emerged in which scores for both measures rose between preand postintervention assessments, then fell to nearly baseline levels …


Critcally Appraised Paper For: “Is Modified Constraint-Induced Movement Therapy More Effective Than Bimanual Training In Improving Arm Motor Function In The Subacute Phase Post Stroke? A Randomized Controlled Trial.”, Jason Ichimaru, Jennifer Sik, Kelly Schmidt, Kitsum Li Jan 2017

Critcally Appraised Paper For: “Is Modified Constraint-Induced Movement Therapy More Effective Than Bimanual Training In Improving Arm Motor Function In The Subacute Phase Post Stroke? A Randomized Controlled Trial.”, Jason Ichimaru, Jennifer Sik, Kelly Schmidt, Kitsum Li

Occupational Therapy | Critically Appraised Papers Series

Patients poststroke compose one of the largest demographics treated by occupational therapists in the physical disability setting. Approximately two-thirds of individuals who have had a stroke present with arm function impairment (Kwakkel & Kollen, 2007). Therefore, effective arm rehabilitation in occupational therapy settings is critical to help patients regain functional independence and quality of life. Modified constraint-induced movement (MCIM) therapy has been reported as the superior method of arm rehabilitation for individuals in the subacute phase poststroke, although recent research has also supported bimanual training. This 4-week, randomized controlled, quantitative study compared the effect of MCIM therapy and bimanual task-related …


Can Real-Time Visual Feedback During Gait Retraining Reduce Metabolic Demand For Individuals With Transtibial Amputation?, Elizabeth R. Esposito, Harmony S. Choi, Benjamin J. Darter, Jason M. Wilken Jan 2017

Can Real-Time Visual Feedback During Gait Retraining Reduce Metabolic Demand For Individuals With Transtibial Amputation?, Elizabeth R. Esposito, Harmony S. Choi, Benjamin J. Darter, Jason M. Wilken

Physical Therapy Publications

The metabolic demand of walking generally increases following lower extremity amputation. This study used real-time visual feedback to modify biomechanical factors linked to an elevated metabolic demand of walking in individuals with transtibial amputation. Eight persons with unilateral, traumatic transtibial amputation and 8 uninjured controls participated. Two separate bouts of real-time visual feedback were provided during a single session of gait retraining to reduce 1) center of mass sway and 2) thigh muscle activation magnitudes and duration. Baseline and post-intervention data were collected. Metabolic rate, heart rate, frontal plane center of mass sway, quadriceps and hamstrings muscle activity, and co-contraction …


Using Xbox Kinect Motion Capture Technology To Improve Clinical Rehabilitation Outcomes For Balance And Cardiovascular Health In An Individual With Chronic Tbi, Shane Chanpimol, Bryant A. Seamon, Haniel J. Hernandez, Michael O. Harris-Love, Marc R. Blackman Jan 2017

Using Xbox Kinect Motion Capture Technology To Improve Clinical Rehabilitation Outcomes For Balance And Cardiovascular Health In An Individual With Chronic Tbi, Shane Chanpimol, Bryant A. Seamon, Haniel J. Hernandez, Michael O. Harris-Love, Marc R. Blackman

Exercise and Nutrition Sciences Faculty Publications

Background

Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention …


Mealtime Insights: A Photovoice Project With African American Mothers And Their Young Children, Paula Ann Rabaey Jan 2017

Mealtime Insights: A Photovoice Project With African American Mothers And Their Young Children, Paula Ann Rabaey

Occupational Therapy Program Student Theses, Dissertations and Capstones

Mothering is a complex and multifaceted occupation that encompasses the nurturing work that women engage in. It addition, it has been established that ethnicity, class, and gender have effects on motherhood that need to be taken into account when looking at the occupations of motherhood across cultures. One important task that occurs within a mothers’ daily routine is that of making meals for their children. This dissertation sought to gain a rich, in-depth description of the phenomenon of the mealtime experience for African American mothers of low socioeconomic status and young children living in an inner-city environment in the Midwest. …


Leadership Within Occupational Therapy : A Mixed Methods Study, Scott Truskowski Jan 2017

Leadership Within Occupational Therapy : A Mixed Methods Study, Scott Truskowski

Occupational Therapy Program Student Theses, Dissertations and Capstones

PURPOSE: This sequential embedded mixed methods study first identified the ways in which occupational therapy leaders experience leadership, then explored the ways in which those same leaders utilized their professional training as occupational therapists within their practice of leadership. METHODS: The twelve participants held formal leadership positions in either academia, clinical practice, or professional associations. The ecology of human performance model of practice was utilized to frame the research study. Data was collected through an initial interview with all 12 participants and through leadership artifacts and a second interview with six participants. RESULTS: Three themes resulted from thematic analysis of …


Risk Factors For Low Back Pain In Recreational Distance Runners, Jonathan Gallas Jan 2017

Risk Factors For Low Back Pain In Recreational Distance Runners, Jonathan Gallas

Department of Physical Therapy Student Theses, Dissertations and Capstones

Risk Factors for Low Back Pain in Recreational Distance Runners By Jonathan E. Gallas Purpose. The purpose of this study was to examine differences between runners with and without low back pain and a control group of non-runners in demographic, physical/running, and LBP variables. Subjects. This study included 102 subjects in three groups. Subjects, 18 to 55 years old, were from a running store, sports club, and physical therapy clinics in Rockford, IL. Methods. A pilot study of ten runners with LBP was conducted prior to data collection to assess testers’ reliability. One hundred and twelve runners, with or without …


Immediate Effects Of A Seated Versus Supine Upper Thoracic Spine Thrust Manipulation Compared To Sham Manipulation In Individuals With Subacromial Pain Syndrome – A Randomized Clinical Trial, Jason Keith Grimes Jan 2017

Immediate Effects Of A Seated Versus Supine Upper Thoracic Spine Thrust Manipulation Compared To Sham Manipulation In Individuals With Subacromial Pain Syndrome – A Randomized Clinical Trial, Jason Keith Grimes

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Individuals with Subacromial Pain Syndrome (SPS) often present with a variety of contributing factors. It is possible that a subgroup exists within SPS that has primary impairments of scapular mobility and/or muscle strength. In an attempt to better identify scapular contributions in SPS, the Scapular Assistance Test (SAT) and Scapula Reposition Test (SRT) have been described. Additionally, thoracic spine thrust manipulation has been shown to be effective for shoulder pain. Problem Statement: It is currently unknown whether or not there are impairments in scapulothoracic muscle force generation or scapular mobility in individuals with SPS who have positive results on …


Iliotibial Band Length And Patellofemoral Pain Syndrome: Relationship Between Two Measurement Techniques, Duane Michael Scotti Jan 2017

Iliotibial Band Length And Patellofemoral Pain Syndrome: Relationship Between Two Measurement Techniques, Duane Michael Scotti

Department of Physical Therapy Student Theses, Dissertations and Capstones

Purpose: To determine the relationship between iliotibial band (ITB) length and the presence of patellofemoral pain syndrome (PFPS), compare the difference in ITB length between the painful knee and the non-painful knee in subjects with unilateral PFPS, determine the test-retest reliability, standard error of measurement, and minimal detectable change (MDC) of the Ober test and modified Thomas test, and explore the relationship between the Ober test and the modified Thomas test in measuring ITB length. Subjects: Forty-eight subjects were recruited (PFPS group n=24, control group n=24) from three different outpatient physical therapy clinics. Methods: The Ober test and modified Thomas …


Cost Of Physical Therapists Serving As A Musculoskeletal Providers Compared To Family Practice Providers In A Military Treatment Facility, Troy Edward Mcgill Jan 2017

Cost Of Physical Therapists Serving As A Musculoskeletal Providers Compared To Family Practice Providers In A Military Treatment Facility, Troy Edward Mcgill

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background. Physical therapists (PTs) in the U.S. military practice direct access and can order limited prescription medications, imaging studies. Military PTs function as autonomous primary care managers (PCMs) for patients with musculoskeletal (MSK) disorders. Objective. The study compared cost of PT management of patients with MSK disorders to management by traditional PCMs; medical doctors (MDs), doctors of osteopathic medicine (DOs), advanced registered nurse practitioners (ARNPs), and physician assistants (PAs). Methods. The researcher used a retrospective study of electronic medical records, using an exploratory, non-experimental, cross-sectional, and quantitative design method. Results. At an Air Force military medical clinic during an 18-month …