The association between advanced orthopedic certification and confidence and engagement in prescription opioid medication misuse management practices: a cross-sectional study

ABSTRACT

In the United States, attaining the orthopedic certified specialist (OCS) credential or the orthopedic subspecialty credential of Fellow of the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT), may lead to a higher level of orthopedic practice. It is unknown whether attaining these credentials influences physical therapist confidence in and frequency of engagement in prescription opioid medication misuse (POMM) management practices. A national cross-sectional web-based survey of PTs identified whether respondents had an OCS or FAAOMPT credential. Self-report confidence in POMM-related management practices and the frequency of engaging in these practices were assessed. Logistic regression evaluated association between credential status and confidence in, and frequency of, engagement in POMM-related management practices. The analysis included 402 respondents with a mean age of 41.0 (SD = 11.2) and 203 (50.4%) females. There were 91 (22.6%) PTs with a FAAOMPT credential, 143 (35.6%) with an OCS but with no FAAOMPT credential and 168 (41.8%) had neither credential. Compared to those with an OCS credential, FAAOMPTs reported greater confidence in, and greater frequency of engagement in, POMM-related management practices (p< .05). Compared to those without an OCS or FAAOMPT credential and compared to those with an FAAOMPT credential, those with an OCS did not report greater confidence or greater engagement in any POMM-related management practice (p≥ .05). Obtain the FAAOMPT credential may increase PTs’ confidence in some POMM-related management practices. Research is needed to determine why FAAOMPTs report greater confidence and engagement in POMM-related management practices.

KEYWORDS:

• Physical therapy
• opioids
• opioid misuse
• physical therapist
• rehabilitation
• orthopedic certified specialist
• fellow of the american academy of orthopedic and manual physical therapists
• specialty certification

Acknowledgments

The authors thank Mitchell Garets, MSW, CSW for his assistance in constructing the survey.

Disclosure statement

Dr. Magel is the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) Practice Affairs Chair. He is an AAOMPT Fellow and had the OCS credential in the past. Dr. Bishop is a member of the AAOMPT. Dr. Lonnemann is an AAOMPT Fellow, is an OCS and is the current AAOMPT president. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Funding

For author JM, the research reported in this publication was supported (in part or in full) by the National Center for Advancing Translational Sciences (NCATS) and National Center For Complementary & Integrative Health (NCCIH) of the National Institutes of Health under Award Number KL2TR002539. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Infrastructure support for author AJG was provided, in part, by the Greater Intermountain Node (GIN; NIH/NIDA 1UG1DA049444) of the National Institute on Drug Abuse Clinical Trials Network and the Department of Veterans Affairs Health Services Research and Development Service Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS; CIN 13-414) Center of Innovation.

Notes on contributors

John Magel

John (Jake) Magel completed his manual therapy fellowship training and received his Doctor of Science in Physical Therapy from the US Army-Baylor University Post-Professional Doctoral Program in Orthopaedic and Manual Physical Therapy in 2001 and his PhD in Rehabilitation Sciences from the University of Utah in 2015. He is a Fellow of the American Academy of Orthopaedic and Manual Physical Therapists (AAOMPT), Chair of the AAOMPT Practice Affairs Committee and the 2018 recipient of the AAOMPT Mennell Service Award. His research focuses on the management of patients with musculoskeletal conditions and he has presented original research nationally and internationally. The research teams on which he has served have received the Stephen J Rose Excellent in Research Award and the American Academy of Orthopedic Manual Physical Therapists Excellence in Research Award. He is a Learning Health Systems Rehabilitation Research Network (LeaRRn) scholar and a recipient of a National Center for Advancing Translation Sciences KL2 award.

Mark D. Bishop

Mark Bishop is Director of the Doctor of Physical Therapy program in the Department of Physical Therapy and faculty in the Center for Pain Research and Behavioral Health and Pain Research, and Intervention Center of Excellence at the University of Florida.

Elaine Lonnemann

Elaine Lonnemann is the Associate Dean of the College of Health Sciences and Program Director of the transitional Doctor of Physical Therapy Program at the University of St. Augustine for Health Sciences. She is board certified in Orthopaedic Physical Therapy and is a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Dr Lonnemann is currently in her second term as the President of the American Academy of Orthopaedic Physical Therapists, having previously served two terms as Secretary. She has presented nationally and internationally on the topics of spinal thrust manipulation, low back pain guidelines, education, and leadership. She has authored textbook chapters in orthopaedic physical therapy and has published articles related to low back pain. She received the AAOMPT Mennell Service and the President Joseph and Maureen McGowan Prize for Faculty Development.

Gerald Cochran

Gerald Cochran is an Associate Professor in the Department of Internal Medicine, Division of Epidemiology at the University of Utah and serves as the Director of Research for the Program on Addiction Research, Clinical Care, Knowledge, and Advocacy within the Division of Epidemiology. Dr. Cochran also has an adjunct Associate Professor appointment with the University of Utah Department of Psychiatry and is core faculty with the Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation within the VA Salt Lake City Health Care System. Dr. Cochran has extensive expertise in clinical- and system-level behavioral health services research, and his experience has focused on development and testing of evidence-based practices for addressing opioid and other substance misuse/use disorders in health care settings.

Julie M. Fritz

Julie Fritz is a Distinguished Professor in the Department of Physical Therapy and Athletic Training, and Associate Dean for Research in the College of Health at the University of Utah in the United States. Her research has focused on clinical trials and observational studies examining treatments for patients with low back pain and their associated costs. Her research has been funded by the National Institutes of Health, the Patient Centered Outcomes Research Institute, the Agency for Healthcare Research and Quality and the Department of Defense in the United States.

Nancy West

Nancy West, holds a doctorate in Epidemiology and a master’s degree in Statistics. She has been a co-investigator for several large epidemiologic studies and has provided biostatistical support for multiple research projects.

Adam J. Gordon

Adam J. Gordon is the Elbert F. and Marie Christensen Endowed Research Professor, tenured Professor of Medicine and Psychiatry, at the University of Utah School of Medicine and the is the Section Chief of Addiction Medicine at the VA Salt Lake City Health Care System. He is a board-certified physician in internal medicine and addiction medicine. He has a 20+ year track record of conducting research on the quality, equity, and efficiency of health care for vulnerable populations, including those who have addiction. A major theme of his research includes examining the efficacy, effectiveness, and implementation of evidence-based identification, assessment, and treatments for patients with addiction. He is the Director of the Greater Intermountain Node (GIN), a node of the NIH NIDA Clinical Trials Network (CTN); he founded and is the Director of the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA); and he founded and am the Emeritus Director the Vulnerable Veteran Innovative Patient-Aligned-Care-Team (VIP) Initiative, a clinical-evaluation initiative at the VA Salt Lake City Health Care System. He has received efforts on nearly 100 grants from the NIH, VA, AHRQ, PCORI, SAMHSA and Foundations and has authored over 252 peer reviewed articles in high impact journals.