Listen to the 42nd Mary McMillan Lecture--"Learning: What Matters Most"--delivered by Dr Gail Jensen at the opening ceremonies of PT 2011: the Annual Conference and Exposition of the American Physical Therapy Association on June 8, 2011, in National Harbor, Maryland. Introducing Dr Jensen is APTA President Dr R Scott Ward.

In their article "Profile of Functional Limitations and Task Performance Among People With Early- and Middle-Stage Parkinson Disease" (September 2011), Dr Margaret Schenkman, PT, PhD, FAPTA, and colleagues used cross-sectional data from 5 different studies to summarize the expected values, by disease stage, of variety of tests and measures used to quantify the functional performance of people in the early and middle stages of Parkinson disease (PD). According to Schenkman, this database of typical values will allow clinicians and researchers to interpret the functional status of individual patients and study participants with PD. In this podcast, Schenkman is joined by Kathleen Gill-Body, PT, DPT, NCS, a neurologic clinical specialist and a member of PTJ's Editorial Board, and PTJ Editor-in-Chief Rebecca Craik, PT, PhD, FAPTA, to discuss how benchmarks can best be used in clinical practice. Can these data be used for goal setting and prognosis? Are certain measures more appropriate for particular stages of PD? Would a combination of measures, rather than a single measure, better identify early functional deterioration in people with PD?

The August 2011 article "Age-Related Differences in Muscle Fatigue Vary by Contraction Type: A Meta-analysis" reported a counter-intuitive result: for some contraction types, particularly isometric and intermittent isometric contractions, older adults are more resistant to muscle fatigue than younger adults. The authors of the study--Keith Avin, PT, DPT, and Laura Frey-Law, PT, PhD--join moderator Carolynn Patten, PT, PhD, to discuss the results of this article and their clinical implications. Why are these differences in muscle fatigue important? What physiological or neurological factors might explain these results? What role does task complexity play? Does the term "fatigue" mean different things physiologically and perceptually?

Acute care is a complex practice environment where the medical condition of the patients is often dire; however, the role physical therapists play in this setting is not well understood. The June 2011 article "Physical Therapist Practice in the Acute Care Setting: A Qualitative Study" examined the role of physical therapists in acute care and the skills and decision-making processes that they use. In this podcast, two of authors, Diane Jette and Carey-Leah Havrilko, are joined by Sharon Gorman, the lead author of a recent practice analysis of acute care physical therapy, Gail Jensen, an expert on qualitative studies, and moderator Rebecca Craik to discuss how physical therapists practice the acute care setting. What does a qualitative study add to our understanding of the acute care environment? How does acute care differ from other practice settings? Are physical therapist education programs adequately preparing their graduates to practice in acute care settings? Should acute care be a specialty?

Although patients with chronic low back pain constitute a large portion of the caseload of many outpatient physical therapists, little is known about the quality of care these patients receive and whether these patients have adequate access to physical therapy care. In their April 2011 article "Physical Therapy for Chronic Low Back Pain in North Carolina: Overuse, Underuse, or Misuse?," Janet Freburger and colleagues surveyed patients with chronic low back pain in North Carolina. Fewer than one third of the patients surveyed saw a physical therapist. Furthermore, those patients who did see a physical therapist did not always receive evidence-based treatments. In this podcast, lead author Freburger is joined by Dr Anthony Delitto and moderator Dr Linda Resnik to discuss how the study fits into the larger picture of physical therapy utilization. What are the pros and cons of defining quality of care in terms of overuse, underuse, and misuse? What is the best way to define quality of care? How can physical therapists be encouraged to adopt best practices? What steps should the profession take to improve access, particularly for the uninsured?

The explosive growth in Medicare has prompted calls to change current payment practices from fee-for-service toward a payment system based on quality and efficiency of care. However, more research on outcomes and utilization is required in order to make this shift in the Medicare payment system. In "Utilization and Clinical Outcomes of Outpatient Physical Therapy for Medicare Beneficiaries With Musculoskeletal Conditions" (March 2011), a group of researchers from Intermountain Healthcare described the characteristics, clinical outcomes, and utilization of physical therapy in Medicare beneficiaries in their integrated healthcare system. Authors Julie Fritz, PT, PhD, ATC, and Stephen Hunter, PT, MS, OCS, are joined by Justin Moore, PT, DPT, APTA's Vice President of Payment and Advocacy, to discuss the implications of this article, which moderator Daniel Riddle, PT, PhD, FAPTA, describes as "incredibly important for practice." What is the average utilization of physical therapy for certain diagnoses, and what are the outcomes? According to Moore, policy makers tend to make decisions based on one variable-utilization-but is lower utilization always associated with higher quality and better outcomes? What is the "sweet spot" of utilization and quality? What outcome measures should be used to help determine quality?

In "Full-Text Publication of Abstract-Presented Work in Physical Therapy: Do Therapists Publish What They Preach?" (February 2011), Dr Stuart Warden and colleagues found that about 25% of abstracts presented at the Combined Sections Meeting between 2000 and 2004 ultimately made it to full-text publication. Although this number seems low, what does it really say about the quality of scholarship in the physical therapy profession? In this discussion podcast, Warden is joined by two editors in chief, Dr Rebecca Craik and Dr Guy Simoneau, and moderator Dr Chris Maher to discuss the implications of this study. Are the findings different from those in other health care professions? What can be done to increase this publication rate? Is research presented at conferences really ready for publication? What are the purposes of conference presentation? Is there a bias against the publication of negative findings?

In "Influence of a Locomotor Training Approach on Walking Speed and Distance in People With Chronic Spinal Cord Injury: A Randomized Clinical Trial" (January 2011), Edelle Field-Fote and Kathryn Roach found that a group of people with chronic spinal cord injuries who received overground walking retraining had greater improvement in walking speed and walking distance than 3 groups that received various treadmill-based walking retraining programs. In this discussion podcast, Dr Field-Fote is joined by Dr Michele Basso, who wrote a commentary on the article, and moderator Dr Andrea Behrman to discuss the implications of this study. The group focuses on the role of assistive devices (such as treadmills, walkers, overhead body support) in retraining walking. Do assistive devices have negative effects that manifest themselves when people with spinal cord injuries begin "real-world" walking? In order to change motor behavior, is it important, as Field-Fote suggests, to practice the task the way the task will ultimately be performed? Or, as Behrman suggests, does the use of the treadmill allow clinicians to "retrain the nervous system to be at a higher level of function" and reintroduce many higher-level skills before community ambulation begins?

PTJ's Pediatrics Special Issue focused on variability and how this concept is changing ideas about normal childhood development. In this discussion podcast, 3 of the authors from the Pediatrics Special Issue--Regina Harbourne, Beatrix Verijken, and Linda Fetters--join moderator James (Cole) Galloway to discuss variability, how children use variability to develop motor skills, and the role of variability in pediatric physical therapist practice. How can variability be used to identify healthy motor development, and how can it enhance intervention? How much variability is too much?

In their July 2010 article "Creating an Interface Between the International Classification of Functioning, Disability and Health and Physical Therapist Practice" and their companion paper "Using a Case Report of a Patient With Spinal Cord Injury to Illustrate the Application of the International Classification of Functioning, Disability and Health During Multidisciplinary Patient Management," Escorpizo and colleagues discuss ways to incorporate the ICF into clinical documentation. Is a documentation template such as the one they outlined feasible in practice? Will the implementation of the ICF in clinical practice provide tangible benefits to clinicians, or will the ICF be just "one more thing" that busy clinicians have to do? In this podcast, Escorpizo is joined by Todd Davenport, Daniel Vreeman, and Moderator Linda Resnick to discuss how the ICF might be used in day-to-day practice and the work that remains to be done to make implementation possible. The group also discusses how education programs, continuing education courses, and information technology systems might make it easier for clinicians to adopt the ICF.