Decision Making for Physical Therapy Service Delivery in Schools: A Nationwide Survey of Pediatric Physical Therapists

Abstract

Background and Purpose. A nationwide survey was conducted to explore decision making among school-based physical therapists and to examine recommendations regarding the models, contexts, frequency, and intensity of physical therapy service delivery. Factors that the therapists considered important in making clinical decisions also were examined. Subjects and Methods. A survey instrument using a clinical case format was sent to all members of the American Physical Therapy Association's Section on Pediatrics who identified themselves as school-based therapists (N=1,154); 626 respondents, from all 50 states, completed the survey. Four case descriptions were presented in the survey: 2 preschool girls with developmental delay (1 with and 1 without cognitive impairment) and a boy with cerebral palsy (at 6 and 12 years of age). Results. Individual direct services were recommended by 52% to 55% of the respondents for both 4-year-old girls and for the boy at 12 years of age; 92% of the respondents recommended them for the boy at 6 years of age. The most prevalent choice (48%-73%) for the context of service delivery (location or environment) was a combination of integrated and isolated contexts. For those respondents who selected direct services (individual or group, or both), the mean recommended monthly frequency for the boy at 6 years of age (5.8) was more than twice that for the boy at 12 years of age (2.4). The mean suggested direct frequency for the girl with cognitive impairment (4.5) was greater than that for the girl without cognitive impairment (4). The students' functional levels were considered very to extremely important in decision making by 87% to 90% of the respondents. Discussion and Conclusion. Survey responses were relatively consistent with current literature regarding school practice and principles of motor learning. Recommendations varied for each case, regarding the models, contexts, frequency, and intensity of physical therapy service delivery.