About

Robbin Howard, DPT, NCS, is an Associate Professor of Clinical Physical Therapy at the USC Division of Biokinesiology and Physical Therapy. She practices at USC Physical Therapy at the Health Sciences Campus, specializing in treating patients with vestibular- and neurologic-related disorders. Dr. Howard is board-certified by the American Board of Physical Therapy Specialties as a Neurologic Clinical Specialist (NCS). Her professional memberships include the Neurology Section of the American Physical Therapy Association and the California Physical Therapy Association. Her research involvement includes interventions for patients after stroke and evidence-based practice. She has been an invited speaker at several local and national conferences. Dr. Howard holds a Doctor of Physical Therapy degree from the University of Southern California, obtained in 2002, and completed a Neurologic Physical Therapy Residency at USC and Rancho Los Amigos National Rehabilitation Center in 2003. She also earned a Master of Business Administration from USC in 2018 and a Bachelor of Arts in Biology from Indiana University-Purdue University Indianapolis in 1998.

Research topics

• Nursing
• Medicine
• Physical therapy
• Psychology
• Medical education
• Applied psychology
• Social psychology

Selected publications

• Understanding Behavior Change in Clinical Practice Guideline Implementation: A Qualitative Study

  Journal of Neurologic Physical Therapy · 2024 · 4 citations

  • Psychology
  • Medicine
  • Medical education

  BACKGROUND AND PURPOSE: Growing numbers of clinical practice guidelines (CPGs) are available to neurologic physical therapists to guide and inform evidence-based patient care. Adherence to CPG recommendations often necessitates behavior change for therapists and patients. The purpose of this qualitative study was to gain insight into the experiences, perspectives, and drivers of behavioral change for therapists working to improve adherence to a CPG. We also sought to understand the perspectives of patients impacted by this work. METHODS: Five sites participated in a 6-month implementation study integrating a CPG into local practice using the Knowledge to Action model. At the conclusion of the intervention, therapists and patients were recruited to participate in semi-structured interviews or focus groups. An inductive phenomenological approach was used for data analysis. Two authors coded data to generate primary themes. A secondary analysis used the Capability, Opportunity, Motivation, Behavior (COM-B) model to explain the drivers of behavior change for therapists and patients. RESULTS: Perspectives from 16 therapists generated 6 themes around feedback/accountability, teamwork/belonging, complexity/adaptability, leadership/prioritization, engagement/benefit, and motivation/growth. Twelve patients' perspectives generated 2 themes around communication/personalization and support/recovery. Drivers for behavior change associated with the COM-B model are highlighted. DISCUSSION AND CONCLUSIONS: Therapist adherence to CPG recommendations was supported by inclusive and goal-directed teams, regular quantitative audit and feedback, opportunities for learning, and a sense of accountability to their coworkers, patients, and themselves. Patients' engagement in rehabilitation was supported by personalized education, objective measures of progress, and a strong therapeutic relationship. VIDEO ABSTRACT AVAILABLE: for more insights from the authors (see the video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A491).

  PublisherDOI

• Use of the knowledge to action model improved physical therapist adherence to a common clinical practice guideline across multiple settings: a multisite case series

  BMC Health Services Research · 2022 · 18 citations

  • Medicine
  • Nursing

  BACKGROUND: When a new guideline is published there is a need to understand how its recommendations can best be implemented in real-world practice. Yet, guidelines are often published with little to no roadmap for organizations to follow to promote adherence to their recommendations. The purpose of this study was to evaluate the impact of using a common process model to implement a single clinical practice guideline across multiple physical therapy clinical settings. METHODS: Five organizationally distinct sites with physical therapy services for patients with peripheral vestibular hypofunction participated. The Knowledge to Action model served as the foundation for implementation of a newly published guideline. Site leaders conducted preliminary gap surveys and face-to-face meetings to guide physical therapist stakeholders' identification of target-behaviors for improved guideline adherence. A 6-month multimodal implementation intervention included local opinion leaders, audit and feedback, fatigue-resistant reminders, and communities of practice. Therapist adherence to target-behaviors for the 6 months before and after the intervention was the primary outcome for behavior change. RESULTS: Therapist participants at all sites indicated readiness for change and commitment to the project. Four sites with more experienced therapists selected similar target behaviors while the fifth, with more inexperienced therapists, identified different goals. Adherence to target behaviors was mixed. Among four sites with similar target behaviors, three had multiple areas of statistically significantly improved adherence and one site had limited improvement. Success was most common with behaviors related to documentation and offering patients low technology resources to support home exercise. A fifth site showed a trend toward improved therapist self-efficacy and therapist behavior change in one provider location. CONCLUSIONS: The Knowledge to Action model provided a common process model for sites with diverse structures and needs to implement a guideline in practice. Multimodal, active interventions, with a focus on auditing adherence to therapist-selected target behaviors, feedback in collaborative monthly meetings, fatigue-resistant reminders, and developing communities of practice was associated with long-term improvement in adherence. Local rather than external opinion leaders, therapist availability for community building meetings, and rate of provider turnover likely impacted success in this model. TRIAL REGISTRATION: This study does not report the results of a health care intervention on human participants.

  PublisherOA PDFDOI

• Promoting physical therapists’ use of research evidence to inform clinical practice: part 3 – long term feasibility assessment of the PEAK program

  BMC Medical Education · 2016-05-12 · 35 citations

  articleOpen access

  BACKGROUND: Evidence is needed to develop effective educational programs for promoting evidence based practice (EBP) and knowledge translation (KT) in physical therapy. This study reports long-term outcomes from a feasibility assessment of an educational program designed to promote the integration of research evidence into physical therapist practice. METHODS: Eighteen physical therapists participated in the 6-month Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program. The participant-driven active learning program consisted of four consecutive, interdependent components: 1) acquiring managerial leadership support and electronic resources in three clinical practices, 2) a 2-day learner-centered EBP training workshop, 3) 5 months of guided small group work synthesizing research evidence into a locally relevant list of, actionable, evidence-based clinical behaviors for therapists treating persons with musculoskeletal lumbar conditions--the Best Practices List, and 4) review and revision of the Best Practices List, culminating in participant agreement to implement the behaviors in practice. Therapists' EBP learning was assessed with standardized measures of EBP-related attitudes, self-efficacy, knowledge and skills, and self-reported behavior at baseline, immediately-post, and 6 months following conclusion of the program (long-term follow-up). Therapist adherence to the Best Practice List before and after the PEAK program was assessed through chart review. RESULTS: Sixteen therapists completed the long-term follow-up assessment. EBP self-efficacy and self-reported behaviors increased from baseline to long-term follow-up (p < 0.001 and p = 0.002, respectively). EBP-related knowledge and skills showed a trend for improvement from baseline to long-term follow-up (p = 0.05) and a significant increase from immediate-post to long-term follow-up (p = 0.02). Positive attitudes at baseline were sustained throughout (p = 0.208). Eighty-nine charts were analyzed for therapist adherence to the Best Practices List. Six clinical behaviors had sufficient pre- and post-PEAK charts to justify analysis. Of those, one behavior showed a statistically significant increase in adherence, one had high pre- and post-PEAK adherence, and four were change resistant, starting with low adherence and showing no meaningful improvement. CONCLUSIONS: This study supports the feasibility of the PEAK program to produce long-term improvements in physical therapists' EBP-related self-efficacy and self-reported behavior. EBP knowledge and skills showed improvement from post-intervention to long-term follow-up and a trend toward long-term improvements. However, chart review of therapists' adherence to the participant generated Best Practices List in day-to-day patient care indicates a need for additional support to facilitate behavior change. Future versions of the PEAK program and comparable multi-faceted EBP and KT educational programs should provide ongoing monitoring, feedback, and problem-solving to successfully promote behavior change for knowledge translation.

  PublisherOA PDFDOI

• Promoting physical therapists’ use of research evidence to inform clinical practice: part 2 - a mixed methods evaluation of the PEAK program

  BMC Medical Education · 2014-06-25 · 39 citations

  articleOpen accessSenior author

  BACKGROUND: Clinicians need innovative educational programs to enhance their capacity for using research evidence to inform clinical decision-making. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists' integration of research evidence into clinical decision-making. This, second of two, papers reports a mixed methods feasibility study of the PEAK program among physical therapists at three university-based clinical facilities. METHODS: A convenience sample of 18 physical therapists participated in the six-month educational program. Mixed methods were used to triangulate results from pre-post quantitative data analyzed concurrently with qualitative data from semi-structured interviews and focus groups. Feasibility of the program was assessed by evaluating change in participants' attitudes, self-efficacy, knowledge, skills, and self-reported behaviors in addition to their perceptions and reaction to the program. RESULTS: All 18 therapists completed the program. The group experienced statistically significant improvements in evidence based practice self-efficacy and self-reported behavior (p < 0.001). Four themes were supported by integrated quantitative and qualitative results: 1. The collaborative nature of the PEAK program was engaging and motivating; 2. PEAK participants experienced improved self-efficacy, creating a positive cycle where success reinforces engagement with research evidence; 3. Participants' need to understand how to interpret statistics was not fully met; 4. Participants believed that the utilization of research evidence in their clinical practice would lead to better patient outcomes. CONCLUSIONS: The PEAK program is a feasible educational program for promoting physical therapists' use of research evidence in practice. A key ingredient seems to be guided small group work leading to a final product that guides local practice. Further investigation is recommended to assess long-term behavior change and to compare outcomes to alternative educational models.

  PublisherOA PDFDOI

• Kinematic and kinetic effects of knee and ankle sagittal plane joint restrictions during squatting

  NC Digital Online Collection of Knowledge and Scholarship (The University of North Carolina at Greensboro) · 2005-01-01 · 1 citations

  articleOpen access1st authorCorresponding

  "The purpose of this study was to evaluate compensatory biomechanical patterns in the lower extremity created by restricted knee flexion and ankle dorsiflexion when performing squats. Forty two healthy subjects (21 men, 21 women; 22.5 (4.5) years, 73.8 (17.8) kg, 167.5 (12.5) cm) participated in the study. Data were collected using a force plate and a 3-d electromagnetic tracking device for bilateral lower extremity analyses. Three parallel squats were performed in non braced, right knee restricted and right ankle restricted conditions. Dependent measures were hip, knee and ankle total joint displacement and work done on the hip, knee and ankle during the eccentric portion of the squat. Three repeated measures ANOVAs compared lower extremity kinematics between conditions, while one repeated measure ANOVAs evaluated lower extremity kinetics. Mean hip, knee and ankle ROM was reported, as was sagittal plane work done on the hip, knee and ankle for each condition and limb. The primary findings of this study indicate hip and ankle flexion displacement significantly decreased in the contralateral (non-braced) limb during the ankle joint restricted condition. Ipsilateral (braced) limb hip, knee and ankle flexion significantly decreased during the knee restricted condition, while ipsilateral knee and ankle flexion decreased during the ankle restricted condition. Lower extremity sagittal plane energetic changes occurred in the ipsilateral knee and ankle when the knee joint was restricted and at the ipsilateral ankle in the ankle restricted condition. Relative and absolute shifts in work done on the hip, knee and ankle when compared to the non braced squat were observed. This study may best serve as a general sagittal plane model for clinicians and coaches to reference when using the parallel squat in patients/athletes with knee and ankle dysfunction. This has practical significance to clinicians as these substitutions in work could result in overuse (secondary) injury to the compensatory site or insufficient loading to the dysfunctional site, rendering it weak and susceptible to additional primary injury or limiting the athletes maximal performance. "--Abstract from author supplied metadata.

  OA PDF

• Neurologic Differential Diagnosis for Physical Therapy

  Journal of Neurologic Physical Therapy · 2004-12-01 · 12 citations

  article

  It is well established that physical therapists are responsible for the formulation of the physical therapy diagnosis. Increasingly greater attention is being directed at the contribution that physical therapists make to the medical differential diagnosis. This process involves recognition by physical therapists of clinical findings that would require referral to another health care professional. In this article, we highlight the role of the physical therapist in the differential diagnosis for patients with neurologic pathology. We describe a framework for physical therapy clinical practice focused on determining appropriateness for physical therapy care for individuals with neurologic conditions. This framework can assist the physical therapist in gathering and interpreting the necessary information from the patient history and neurologic examination to identify patient problems that are within the scope of physical therapy practice. Case studies are used to demonstrate how the framework can be incorporated into clinical practice and to illustrate the role and skills required of physical therapists in order to effectively contribute to the differential diagnosis.

  PublisherDOI

• Back Pain, Intra-Abdominal Pressure, and Belt Use

  Strength and conditioning journal · 1999-12-01 · 2 citations

  article1st authorCorresponding
  PublisherDOI

• REHAB TIPS: Back Pain, Intra-Abdominal Pressure, and Belt Use

  Strength and conditioning journal · 1999-01-01 · 1 citations

  article1st authorCorresponding
  PublisherDOI

Frequent coauthors

• Julie K. Tilson

  University of Southern California

  7 shared

• Sharon Mickan

  Bond University

  4 shared

• Heidi Roth

  Northwestern University

  3 shared

• Karen Skop

  James A. Haley Veterans' Hospital

  3 shared

• Elizabeth Dannenbaum

  Centre intégré de santé et de services sociaux de Chaudière-Appalaches

  2 shared

• Clarisa Martinez

  University of Southern California

  2 shared

• Lisa Farrell

  2 shared

• Linda D’Silva

  2 shared