DPT Portfolios

Professional Goal Statement

As a 30+ year seasoned physical therapist, it was unclear to many, and at times to myself, why I was returning to graduate school for a transitional doctoral degree.  I obtained my “Advanced Masters” degree at UNC in 1991, and always had a thirst for continued graduate level studies.  I put this on hold as I raised my family of 5 children born between 1993 and 2003.  As the youngest entered high school and the older 3 matriculated through college, I allowed the thirst for my own professional development to bubble up.  I discussed with Mike Gross and Chad Cook varied pathways, and as a shoulder clinician who loves research and education, decided that my best option was to pursue the transitional doctoral degree at UNC.  When asked, “Why did you go back to school?” I have often not known how to reply other than I love to learn, I love to learn to think clearly, and I love to learn about how to learn well.  My professional goal is to complete the final years of my career with a diversified job set which includes patient care, and high level teaching and clinical research about effective shoulder rehabilitation strategies.

Career Plan

I have been working at Duke Sports Medicine Physical Therapy for 19 years; initially part-time and now in a full time equivalency position.  I have to say that the deeper shade of blue is my true love, though I remain grateful to UNC for my MS and tDPT degrees!   My plan is to remain in my current position at DSMPT and  integrate clinical care with instruction of residents, fellows, and DPT students in quality shoulder rehabilitation, and to collaborate with researchers in applicable clinical research.

Self Assessment

Strengths

My greatest strength is that I strive for excellence in all that I do.  I will read, review, re-write, and then continue to ponder if I have a task completed when it sufficed hours prior!  I am also internally driven to better myself and learn and grow in all areas of my being:  body, mind and spirit.  I have a fantastic family and friend support system which are the wind beneath my wings!

Areas for Professional Development

I would like to continue to grow in the area of applied clinical outcomes research for shoulder rehabilitation strategies.  I am passionate about utilization and would like to objectively and critically analyze the impact of physical therapy on several degenerative shoulder rehabilitation pathways:  anatomic and reverse total shoulder arthroplasty, rotator cuff repair, and humeral fracture.

 

Objectives

My aims of interest for the transitional DPT program included, but were not limited to, growing in research design and statistics knowledge; gaining the appropriate degree level needed to participate in teaching in a DPT program; improving my ability to critically think as well as read and apply research in clinical practice.

At the completion of the program I hoped to –
1. Integrate academic teaching at an accredited physical therapy program into my job
2. Attain Orthopedic Certification Specialization
3. Participate as a co-investigator or principal investigator in research in the area of shoulder rehabilitation

 

Specific Strategies

Regarding the stated goals I have done the following:

1.  I am scheduled to teach a guest lecture for the Duke DPT program in June 2020 on management of the post-operative upper extremity patient.  I lead the Duke Sports Medicine Sports Residency and Fellowship weekly journal club meeting, and taught the shoulder section for the Duke Orthopedic Residency program in spring 2020.
2.   I took the APTA Orthopedic Certification Specialization exam in March 2020; awaiting results of the exam.  I did an independent study program spring semester 2020 to study all of the APTA Orthopedic Section Current Concept monographs, Clinical Practice Guidelines and Clinical Prediction Rules to prepare for the exam.
3.   One of the shoulder surgeons with whom I work just invited me to submit a letter of intent to apply for a grant to study the impact of telehealth rehabilitation services for rotator cuff repaired patients, and I have accepted this challenge.  We hope to apply for an Orthopedic Rehabilitation and Education Foundation award for a multi-center study.

Product Examples

The two projects which I believe most exemplify the learning I acquired in this program that facilitated my growth are:

1.  My CAT in Evidence Based Medicine II with Charlie Sheets as excellent instructor.  The end product follows below.
2.   My Capstone project which included a systematic review of over 2000 articles related to clinical and patient reported outcomes and complications following reverse total shoulder arthroplasty stratified by the pre-operative indication.  Here is a link to this work: https://dptcapstone.web.unc.edu/category/capstone-projects-2020/kennedy-june/

Clinical bottom line of CAT from EBMII

CRITICALLY APPRAISED TOPIC
FOCUSED CLINICAL QUESTION
In patients who are 60 years of age and older who have had a reverse total shoulder arthroplasty, are there differences in clinical and/or patient reported outcomes between those having surgery for rotator cuff tear arthropathy as compared to those having the procedure for primary osteoarthritis?

AUTHOR
Prepared by June Kennedy Date 11/17/19
Email address Junetex5@gmail.com

CLINICAL SCENARIO
In my work as a shoulder therapist, I rehabilitate many patients who have reverse total shoulder arthroplasty (RTSA). The RTSA prosthetic design employs fixed fulcrum mechanics to compensate for rotator cuff incompetency for patients with cuff tear arthropathy. The prosthetic implant is now becoming more widely used for other conditions such as patients with primary osteoarthritis who have severe glenoid erosion which makes implanting an anatomic arthroplasty challenging. I have observed varied outcomes for patients having RTSA for different indcations. The outcomes for RTSA may be different for arthritis versus cuff tear arthropathy patients due to differences in the rotator cuff function. I would like to fully understand differences that may exist in outcomes for patients who have RTSA for cuff tear arthropathy as compared to primary osteoarthritis so that I can help set appropriate goals and expectations for post-operative rehabilitation.

SUMMARY OF SEARCH
Eight studies which met the inclusion and exclusion criteria of this PICO question were reviewed. There were 2 systematic reviews as well as 6 quasi-experimental studies: 3 retrospective case-controlled series, 2 retrospective cohort prognostic studies, and 1 retrospective comparative study.
Outcomes of pain, patient satisfaction, ranges of motion, and functional outcome scores are similar when comparing anatomic TSA to RTSA for primary glenohumeral osteoarthritis.
There is a 2.2 relative risk of needing to revise an anatomic TSA to a RTSA within 2.5 years for primary osteoarthritis patients who are over 70 years of age with an intact rotator cuff due to cuff dysfunction after the index surgery.
The complication rate after RTSA for primary osteoarthritis in patients over 70 years of age with an intact rotator cuff is low, and this surgery can be considered a good option for this population with reliable outcomes.
RTSA for cuff tear arthropathy and primary osteoarthritis have similar outcomes with respect to pain, patient satisfaction, and Constant score. Post-operative elevation may be less for patients with primary osteoarthritis while external rotation may be more as compared to patients with cuff tear arthropathy, though this finding needs further study due to conflicting results.

CLINICAL BOTTOM LINE
Reverse total shoulder arthroplasty results in improved pain, patient satisfaction, range of motion, and patient reported outcome scores for both cuff tear arthropathy and primary glenohumeral osteoarthritis. Shoulder elevation following RTSA may not improve in the primary osteoarthritis patient population as much as it does for those with cuff tear arthropathy. There is discrepancy regarding the degree of expected elevation and external rotation following RTSA for patients with osteoarthritis, and further research is needed to clarify this to inform expectations of patient outcomes.

Reflective Statement

As I look back on the past two years of working full-time while completing this transitional doctorate, I feel grateful.  I had an extremely supportive spouse who absorbed a lot of household minutiae so that I could focus on school.  My manager and the PT department head, Bob Bruzga and Dan Dore, were behind me all the way with endorsements of financial and professional support from the department.  Excellent instructors like Mike Gross and Charlie Sheets aided me in growing in the specific areas of orthopedics and research knowledge which were my greatest goals for learning.  My Capstone committee members Garrett Bullock, PT, DPT and Chris Klifto, MD were work horses in the systematic review that we completed.

I believe I am progessing toward the stated goals that I established for this program:  I am teaching at a high level of engagement, leading journal club weekly, and participating in outcomes related research.

I believe that if you are not growing, you are dying; thus I am committed to continued growth and development in all of the stated objectives for this program and see this journey as a life long process.

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