Rolando T Lazaro

Clinical education is the crucible in which physical therapy students integrate knowledge, skills, and professional judgment into safe, ethical, and person-centered practice. Yet globally, the assessment of clinical performance remains highly variable, shaped by disparate tools, rubrics, and levels of assessor preparation. While several countries have adopted nationally standardized approaches to clinical assessment, many contexts—including the Philippines—continue to rely on locally developed or institution-specific systems, resulting in inconsistent expectations, inequitable student experiences, and limited capacity for benchmarking, research, and quality improvement. This editorial argues that good intentions alone are insufficient and that the profession must move toward shared, trustworthy standards for assessing clinical competence. Drawing on international exemplars and the recently released Competency-Based Education in Physical Therapy (CBEPT) framework, we outline core principles for standardization that promote validity, reliability, fairness, and patient safety while preserving local contextual flexibility. A pragmatic national framework is proposed, incorporating competency mapping, workplace-based assessments, entrustable professional activities, shared rubrics, rater training, and continuous quality cycles. We conclude by positioning assessment standardization not as bureaucratic compliance, but as an ethical obligation to learners, educators, and the public, and we invite continued dialogue to advance clinical education locally and globally.

While gait speed serves as a clinical marker and health indicator, there is a paucity of a consolidated review of the factors that are most predictive of gait speed across the clinical stages of stroke recovery. What are predictors of gait speed in the acute, subacute and chronic phase of stroke, categorized according to International Classification of Functioning, Health, and Disability (ICF)? A systematic search was conducted using four electronic databases following the PRISMA guideline. Included studies were cross-sectional, cohort and case-control reporting the predictors of gait speed, published from January 2000 to July 2024, and involved participants 18 years or older with diagnosis of stroke. Four meta-analyses were performed. The initial search yielded 311 articles. After screening, 32 articles were included in the final analysis. In all clinical stages of stroke, age was the most common predictor of gait speed, followed by admission walking speed, Berg Balance Scale (BBS) score and time since onset. Knee extensor strength emerged as a predictor in three studies, all in the chronic stage. The meta-analyses indicated that older age was associated with slower discharge gait speed (SMD: −0.004 [-0.01, −0.001]; p < 0.0001) while higher BBS scores at admission were associated with a larger change in gait speed between admission and discharge (SMD: 0.17 [0.06, 0.28]; p = 0.002). Significance. Understanding the modifiable factors can help clinicians target interventions and seek additional care while non-modifiable factors can guide the prognosis of walking function in people post stroke. •Gait speed is a valid and reliable primary measure of post-stroke performance.•In all clinical stages of stroke, age is the most common predictor of gait speed.•Older age is associated with slower discharge gait speed.•Higher BBS scores at admission are associated with a greater change in gait speed between admission and discharge.

Physical therapists play a vital role in preventing and managing falls in older adults. With advancements in digital health and technology, community fall prevention programs need to adopt valid and reliable telehealth-based assessments. The purpose of this study was to evaluate the validity and reliability of the telehealth-based timed up and go (TUG) test, 30-second chair stand test (30s-CST), and four-stage (4-stage) balance test as functional components of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk assessment. This cross-sectional study was conducted using a convenience sample of community-dwelling older adults. The TUG, 30s-CST, and 4-stage balance test were administered in random order in 1 session in the participant's own environment. Performance was scored concurrently by an in-person and synchronous telehealth rater. The video recordings of the performances were scored by an asynchronous telehealth rater on days 1 and 30 for inter- and intra-rater reliability. Additionally, participants performed the TUG test twice, using the distance measured by the participant and the distance measured by the in-person rater. To establish the validity of telehealth-based STEADI fall risk assessments, the Intraclass Correlation Coefficient (ICC), Pearson correlation coefficient, and 95% limits of agreement were derived. Inter- and intra-rater reliability were established by calculating ICC using a 2-way mixed model. Bland-Altman plots were created for nonsignificant proportional bias tests. Thirty community-dwelling older adults participated. Based on the STEADI algorithm, 13 participants were classified as having a moderate fall risk. A comparison of in-person and synchronous telehealth ratings showed excellent ICCs (0.97-0.99) and relationships (r = 0.94-0.98). Bland-Altman plots were created for all tests except for the 30s-CST (t = -2.168, P = .04). All tests had good to excellent inter-rater reliability (ICC = 0.84-1.00) and intra-rater reliability (0.77-1.00). No adverse events were reported. This study suggests that telehealth-administered functional tests in the STEADI fall risk assessment are valid and reliable when technology, environment, camera view, and angle are optimally managed.

Introduction. The COVID-19 pandemic forced a sudden shift in the delivery of community-based rehabilitation (CBR) services to online platforms such as tele-CBR. Feedback from community partners is important to determine if these services meet their expectations and to inform if adjustments may be needed for future implementation of CBR services using this mode of service delivery. The purpose of the study is to describe the level of client satisfaction of those who received tele-CBR from a university-led CBR program. Methods. This is a descriptive study using quantitative and qualitative approaches for collecting, analyzing, and integrating information on client satisfaction. Quantitative methods included the review of existing program monitoring forms with numerical ratings. Qualitative methods included key informant interviews of care providers and staff members of a partner organization. The interviews revealed their experiences, challenges, and possible factors affecting the level of satisfaction. Results. All respondents gave high satisfaction ratings with the services received through tele-CBR. Factors such as continuous access to therapy services, learning from an interdisciplinary team, and convenience reflect the usability and acceptability of tele-CBR. Challenges include lack of reliable internet signal, lack of child engagement, high distractibility, and limitation in socialization. Discussion. Study participants were positive about the usefulness of the tele-CBR sessions reinforcing better access to vital therapy interventions during the pandemic. The responses suggest the importance of choice in the mode of service delivery. To improve acceptability, respondents highlighted the need to continue engaging carers in both approaches as complementary services. Service recipients and representatives of the partner organization indicated that tele-CBR services were useful, viable, and acceptable. Tele-CBR has the potential to improve equity and access to therapy services.

Background/Objectives: Cerebellar strokes account for only 2–3% of all strokes occurring annually in the United States but represent a disproportionally higher share of morbidity and mortality. Evidence examining the effect of inpatient rehabilitation on functional outcomes following a cerebellar stroke is limited. This study aimed to examine the effects of inpatient rehabilitation on balance and walking speed in individuals with cerebellar stroke. A secondary purpose of this study was to examine the length of inpatient rehabilitation stay of the included patients. Methods: A retrospective analysis was conducted using review of patient records during their inpatient rehabilitation stay from January 2021 to February 2022 at a large hospital system in the southeast United States. Balance and gait outcomes were examined on admission and discharge from inpatient rehabilitation that included physical therapy interventions. A paired t-test examined for changes in outcomes from admission to discharge. Pearson correlation examined for the association between length of stay and outcomes. Results: A total of 15 records were reviewed. There were significant improvements in the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PASS), and the 10-Meter Walk Test (10MWT) (p’s < 0.01) from admission to discharge with large effect sizes (range d = 0.70–1.67) following inpatient rehabilitation. The average length of stay was 12.67 days (SD = 6.5) and the mean total hours of combined occupational, physical, and speech therapy was 27.33 (SD = 6.52) h. There was a moderate association between length of stay and PASS (r = 0.525, p = 0.04) and BBS (r = 0.546, p = 0.04) outcomes. Conclusions: Patients who underwent inpatient rehabilitation following acute cerebellar strokes demonstrated improvements in balance and gait speed. Study results could assist clinicians designing interventions for patients with cerebellar strokes in the inpatient rehabilitation setting.

Introduction: The validity and reliability of tests and measures conducted virtually without the in-person presence of a physical therapist is a challenge in telehealth. This study evaluated the validity and reliability of telehealth administration of outcome measures. Methods: Six participants were examined by 3 independent raters. The outcome measures used were the 2-minute step test, 30-second chair stand test, and Timed Up and Go. Results: There was a high level of validity and reliability between the in-person and virtually conducted tests. Discussion: The preliminary findings demonstrated that outcome measures can be conducted virtually with validity of scoring and results.