“The landscape of rehabilitation is changing,” as observed in the accompanying article by Norland et al.1(p556) These astute colleagues have identified a gap between DPT students' and faculty members' awareness of regenerative rehabilitation and thus advocate for incorporation of the principles of regenerative rehabilitation into our professional curricula. The chasm creates an opportunity for improvement, and the authors have advocated that we thoroughly examine our existing curricula and institute change to better prepare budding physical therapists for future practice.
This is not the first time we have heard such a call. The Physical Therapy and Society Summit (PASS) held in 2009 reminded us of the need to keep up with recent developments in science and technology. We, in academic programs, were advised to ensure that our curricula addressed advances in genomics, molecular science, and technologies.2 Holding true to the theme, in the Eugene Michels Researchers' Forum at the 2012 Combined Sections Meeting of the American Physical Therapy Association (APTA), we were informed of opportunities for physical therapists to contribute to the burgeoning field of stem cell biology through regenerative rehabilitation.3 And recent clinical cases, such as that described by Gentile and colleagues,4 demonstrate that rehabilitation is key to success in tissue implantation and engineering in humans.
As recognized by Norland and colleagues, the gap between basic science research and clinical practice is closing swiftly, and we must work hard to keep our curricula current. The Guide to Physical Therapist Practice 3.0 informs us that the physical therapist “selects, prescribes, and implements interventions” and notes that “factors that influence the complexity, frequency, and duration of the intervention and the decision-making process may include…concurrent medical, surgical, and therapeutic interventions.”5 This guidance is sufficiently broad to allow for variability among academic programs and perhaps too broad to ensure that all programs include all aspects of emerging science and technology. The onus is on us to continually scan the scientific landscape and provide the foundational science and learning experiences that will enable our graduates to offer future-focused, high-quality physical therapy.
What resources are there for faculty and students to become informed about regenerative rehabilitation? The APTA hosts a webpage devoted to regenerative rehabilitation, including genetics and technology in patient care, among other related topics.6 The site includes podcasts and videos, a short course, and articles to assist faculty leaders in incorporating these concepts into DPT curricula. There have been presentations at the NEXT Conference, Combined Sections Meetings, and the annual Regenerative Rehabilitation Symposium. And PTJ is leading the way with evidence-based articles that link regenerative rehabilitation with the underlying basic science.
What steps can we take at own institutions to ensure that our students learn the principles of regenerative rehabilitation? First, we can incorporate into our curricula strong, detailed foundational science in cell biology, microscopic anatomy, genetics and genomics, and engineering principles. Students can comprehend the relevance if the foundational sciences are sequenced to build upon students' knowledge and experiences and if the scientific principles are integrally linked to clinical reasoning and provision of high-quality care. Second, we can develop informed advocates among the faculty, in part, by apprising them of the gap in understanding described by Norland et al. Third, we can ensure that we have continuous quality improvement in our curricula, including a data-driven approach to curriculum content, learning methodologies, and student outcomes. As advocated during PASS, we must redistribute curricular time to incorporate advancing scientific findings and technologies.2 Fourth, among the faculty and curriculum advisors, we should have bench scientists and clinician-scientists, clinicians practicing in regenerative rehabilitation, and professionals with specialties other than physical therapy. The emerging field of regenerative rehabilitation melds medical, surgical, and therapeutic interventions and requires our expertise in the human movement system to help drive the science forward with an aim of improving the human experience.
In terms of curricular content and learning outcomes, we should be providing for both breadth and depth. At a minimum, all DPT students should be able to provide a definition of regenerative rehabilitation and demonstrate mastery of the terminology and vocabulary in the field. They should be adept at introducing mechanical forces with the goals of effecting change in local and distant tissues, and they should be able to explain the impact of their applied therapies on cell and tissue physiology. They should understand that they are influencing the process and progress of healing and, in some cases, the critical expansion of engineered tissues. All DPT students should be experts in performing and sharing results of a literature search and demonstrate the inquiry skills necessary to obtain clinically important details from a tissue engineer or clinician-scientist. A subset of students who develop a deep clinical interest or who wish to develop expertise in the field should be provided opportunities to pursue clinical and translational research and be afforded the time to engage in inquiry with scientists and clinicians. With the expansion of regenerative approaches to injury and illness and the resultant growth in the patient population, all DPT students should demonstrate competencies in knowledge-based clinical care in regenerative rehabilitation.
Importantly, the field of physical therapy needs clinician-scientists who pursue advanced doctoral and postdoctoral training in regenerative rehabilitation. These scholars must be supported in environments that are rich in intellectual stimulation, and they must be surrounded by learned colleagues in related and disparate fields. Developing scholars must learn and be comfortable with the scientific method of deliberate criticism and reasoned debate. Clinician-scientists should seek out and develop strong scientific collaborations with investigators in fields such as stem cell biology, tissue engineering, imaging technology, and robotics. They should be encouraged to pursue faculty positions and careers in which they can advance the science, influence clinical care, contribute to academic curricula, and guide future bench scientists and clinician-scientists in the expanding realm of regenerative rehabilitation.
How do we address the challenge of our academic program curricula being driven, in part, by what our students are seeing in their clinic experiences, which is often not current with the rapidly evolving states of science and technology? The challenge requires that we not only alter our curricula to include the principles of regenerative rehabilitation, as noted above, but also alter clinical practices wherein our students are educated. Academic programs must assume the responsibility for educating community physical therapists about regenerative rehabilitation and assist them in adapting clinical practice. Health care is evolving rapidly, and our patients are demanding and deserve the highest-quality, state-of-the-science care.
The article by Norland and colleagues reminds us that empowered DPT students can be harbingers of future practice. The students' enthusiasm and their proximity to the basic science can be leveraged for change if we instill in them the confidence to be the experts in the principles of regenerative rehabilitation in the clinical education environment. We can help them to engage with established clinicians, to educate and inform them of the underlying advances in science and technology, and to assist clinicians in reporting on clinical cases. I purposefully make note of case reports here, as regenerative rehabilitation is truly personalized rehabilitation. In this burgeoning field, variability among patients and disparate engineered tissue treatments prevent us from practicing based solely on statistics, clinically meaningful numbers, or meta-analyses. Until the underlying science allows for large clinical trials, we must have confidence in findings from preclinical studies, small numbers of study participants, and clinical case reports. We must work to develop more protocols for clinical care with this patient population, and, importantly, we must communicate both positive and negative results along the way.
Let's take up the charge articulated by Norland and colleagues, and educate our students and clinical colleagues about regenerative rehabilitation.
- © 2016 American Physical Therapy Association
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