The Prediction of National Physical Therapy Examination First-Time Pass Rates Using Reading Comprehension and Critical Thinking Skills Tests

UNION UNIVERSITY
SCHOOL OF EDUCATION
We hereby recommend that the Dissertation by
LaToya LaTrice Green
Entitled
The Prediction of National Physical Therapy Examination First-Time Pass Rates Using Reading
Comprehension and Critical Thinking Skills Tests
Be accepted in partial fulfillment of the requirements for the Degree of
Doctor of Education
In Educational Leadership
Dissertation Committee: John D. Foubert, Ph.D., Chairperson
James S. Guffey, PT, Ed.D.
Thomas R. Rosebrough, Ph.D.
Ed.D. Program Director: Ben T. Phillips, Ed.D.
Dean of the College: John D. Foubert, Ph.D.

The Prediction of National Physical Therapy Examination First-Time Pass Rates Using Reading
Comprehension and Critical Thinking Skills Tests
A Dissertation
Submitted in Partial Fulfillment of the Requirements for the
Doctor of Education Degree
Union University
LaToya LaTrice Green
December 2019

ProQuest Number: 27663737

All rights reserved

INFORMATION TO ALL USERS
The quality of this reproduction is dependent upon the quality of the copy submitted.

In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.

ProQuest 27663737

Published by ProQuest LLC (2019 ). Copyright of the Dissertation is held by the Author.

All rights reserved.
This work is protected against unauthorized copying under Title 17, United States Code
Microform Edition © ProQuest LLC.

ProQuest LLC.
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, MI 48106 - 1346
DEDICATION
I dedicate this manuscript to my husband, Marvin,
who has demonstrated unconditional love and unwavering support throughout my doctoral
journey;
To my God-sent son, Lexington,
who serves as a continual reminder of the amazing miracles that God has provided to our family;
To my mother, Versie Nance,
whose sacrifice and encouragement enable me to achieve my dreams.
ii
ACKNOWLEDGMENTS
First of all, I would like to thank God for giving me the strength to persevere throughout
this doctoral program. I am indebted to my dissertation committee members for investing so
much time throughout this process. I am appreciative of Dr. John Foubert for making the
commitment to be my dissertation chair. I am grateful to Dr. Tom Rosebrough for his
willingness to listen to me share my dissertation ideas. Finding a mentor who is willing to assist
you in meeting your personal and professional goals is challenging. Fortunately, I was blessed to
find my mentor, Dr. J. Stephen Guffey, who gave me dissertation topic ideas, honest feedback,
and encouragement. Dr. Linn Stranak was invaluable with his statistical expertise. I would also
like to express my gratitude to the following: the Department of Educational Leadership for
guiding me through the dissertation process; the class of 2019 cohort for reminding me of
important dates via mobile apps, such as GroupMe; my colleagues at Arkansas State University
for supporting me throughout the dissertation process; and Physical Therapist and Physical
Therapist Assistant students for volunteering to participate in my study. Moreover, I would like
to thank my family and friends for being my personal supporters. Last but not least, I would like
to thank my husband, Marvin, for being my rock on which I could always lean, my confidant
when I was doubtful, and my cheerleader when I needed a vocal supporter.
iii
ABSTRACT
Physical therapy and physical therapist assistant programs have made numerous efforts to
determine cognitive factors, such as the Nelson Denny Reading Test (NDRT), Health Sciences
Reasoning Test (HSRT), and grade point average (GPA), that will not only predict program
success but also predict national board examination success. Because reading comprehension and
critical thinking skills are vital in successfully matriculating through Doctor of Physical Therapy
(DPT) programs and physical therapist assistant (PTA) programs and passing the National
Physical Therapy Examination (NPTE) on the first attempt, it is worthwhile to investigate the
relationship between these variables and to determine whether these variables are predictors of
success in DPT and PTA programs and on the NPTE. To examine whether program success and
NPTE success could be predicted, this quantitative research design study used a sample of
convenience population of DPT and PTA students in the 2017 and 2018 cohorts at Arkansas
State University. Linear regression was used for data analysis. Using the NDRT and prerequisite
GPA, a predictor model was established for PTA program success but not DPT program success.
Predictor models were established for NPTE success for both DPT and PTA students. Program
GPA was a predictor of NPTE success for both DPT and PTA students. The HSRT also added to
the predictor equation for success on the NPTE for PTA students. Results of this study suggest
that GPA is an important factor for both program and NPTE success.
iv
TABLE OF CONTENTS
CHAPTER PAGE
1. INTRODUCTION ...............................................................................................................1
Background of the Problem ....................................................................................2
Statement of Problem and Research Questions .......................................................6
Purpose of the Study ...............................................................................................7
Significance of the Study ........................................................................................8
Definitions of Terms ................................................................................................9
Assumptions, Limitations, and Delimitations of the Study ...................................10
2. REVIEW OF LITERATURE ............................................................................................12

PT and PTA Requirements and Qualifications ......................................................12
PT and PTA Skills .................................................................................................15
Reading Comprehension ............................................................................15
Important Factors Related to the Reliability, Validity, New
Norms and Academic Levels of Reading Comprehension ............15
Reading Comprehension and Academic Success ..........................18
Critical Thinking Skills, Clinical Reasoning Skills, and Clinical
Decision Making ........................................................................................19
Critical Thinking Skills and Academic Success in Health Care
Professions .....................................................................................21
Critical Thinking Skills and Academic Success in Physical
Therapy ..........................................................................................24
Predictive Studies Regarding Testing Accommodations .......................................27
Predictive Studies in Health Care ..........................................................................28
Predictive Study in the Discipline of Dental Hygiene ...............................28
Predictive Study in the Discipline of Medical Laboratory Science ...........29
Predictive Study in the Discipline of Emergency Medical Technician .....30
Predictive Study in the Discipline of Physician Assistant .........................30
Predictive Studies in the Discipline of Medicine .......................................31
Predictive Studies in the Discipline of Nursing .........................................36
Predictive Study in the Discipline of Athletic Training.............................38
Predictive Study in the Discipline of Occupational Therapy.....................39
Predictive Studies in the Discipline of Physical Therapy ..........................40
Predictive Studies in the Discipline of Physical Therapist Assistant ........41
Predictive Studies in PTA Programs Using the NDRT .........................................46
v
Predictive Studies in PT Programs Using Cognitive and Noncognitive
Variables ................................................................................................................48
Predictive Studies in PT Programs Using the NDRT and HSRT ..........................54
Conclusion .............................................................................................................55
3. METHODOLOGY ............................................................................................................58
Purpose of the Study ..............................................................................................58
Design of Study......................................................................................................58
Research Questions ................................................................................................59
Population Sample .................................................................................................59
Variables and Instruments for Measurement .........................................................60
Procedures ..............................................................................................................65
Statistical Design ...................................................................................................66
Implications of the Study .......................................................................................67
Limitations of the Study.........................................................................................67
4. FINDINGS .........................................................................................................................69
Participant Demographics ......................................................................................70
Statistical Results ...................................................................................................71
Research Question 1 ..................................................................................72
5. CONCLUSIONS AND DISCUSSION .............................................................................80

Conclusions ............................................................................................................81
Limitations of the Study.........................................................................................82
Discussion ..............................................................................................................85
Implications of the Research ..................................................................................88
Recommendations ..................................................................................................90
REFERENCES ..............................................................................................................................92
vi
LIST OF TABLES
TABLE PAGE
1. Demographics for DPT Students in the Classes of 2017 and 2018…………...….……..70
2. Demographics for PTA Students in the Classes of 2017 and 2018…………...………...71
3. Descriptive Statistics for the NDRT, uGPA, and Program GPA for Doctor of
Physical Therapy Students………………………………………………………72
4. Correlations for the NDRT, uGPA, and Program GPA for Doctor of Physical
Therapy Students…………………………………………………………..........73
5. Descriptive Statistics for the NDRT, Prerequisite GPA, and Program GPA for
Physical Therapist Assistant Students…………………………………………..74
6. Correlations for the NDRT, Prerequisite GPA, and Program GPA for Physical
Therapist Assistant Students……………………………………………………75
7. Descriptive Statistics for the NDRT, HSRT, Program GPA, and NPTE for
Doctor of Physical Therapy Students ………………………………………….76
8. Correlations for the NDRT, HSRT, Program GPA, and NPTE for Doctor of
Physical Therapy Students……………………………………………………..77
9. Descriptive Statistics for the NDRT, HSRT, Program GPA, and NPTE for
Physical Therapist Assistant Students…………………………………………78
10. Correlations for the NDRT, HSRT, Program GPA, and NPTE for Physical
Therapist Assistant Students…………………………………………………...79
vii
CHAPTER 1
INTRODUCTION
The number of applicants for physical therapy (PT) and physical therapist assistant (PTA)
programs is increasing steadily. According to the Physical Therapist Centralized Application
Service (PTCAS), the total number of verified applicants for PT programs has increased from the
2013-2014 admissions cycle to the 2016-2017 admissions cycle. For the 2013-2014 admissions
cycle, there was a total of 16,828 verified PT applicants. There were 17,587 verified PT
applicants for the 2014-2015 admissions cycle and 18,479 verified PT applicants for the 2015-
2016 admissions cycle. For the 2016-2017 admissions cycle, 19,025 PT applicants were verified
by PTCAS (American Physical Therapy Association, 2017). The number of applicants far
surpasses the number of seats that are available for applicants in PT programs. According to
PTCAS, the average PT programs that used PTCAS as their PT application service had 46
available seats in the 2016-2017 class (American Physical Therapy Association, 2017).
Not only is the selection for PT applicants competitive, but also the selection for PTA
applicants is competitive. For example, in the 2016-2017 admissions cycle at Arkansas State
University-Jonesboro campus, 30 applicants were selected from 79 applicants. Forty-two
applicants were selected from a total of 98 students who applied for the 2017-2018 admissions
cycle on the campuses of Jonesboro and Mountain Home (Arkansas State University, n.d.-a).
Wheeler, Finucane, Soper, and Mayhew (2018) addressed the competitiveness of the
admissions process for physical therapist applicants and the imbalance between the supply and
1
demand of physical therapists in the workplace. These authors addressed the competitiveness of
the admissions process by attempting to identify applicants who would be successful in a PT
program. To address the supply shortage of physical therapists in the workplace, Wheeler et al.
identified preadmission criteria that were predictive of successfully passing the National Physical
Therapy Examination (NPTE). Based on their results, it is imperative that admission committees
select applicants who will not only succeed in PT programs, but it is also important for
committees to select applicants who will be successful on the NPTE (Wheeler et al., 2018).
In order to select applicants who will succeed in therapy programs and on the NPTE,
many programs have attempted to formulate predictor variables (Aldridge, Keith, Sloas, & Mott-
Murphree, 2010; Huhn & Parrott, 2017; Sloas, Keith, & Whitehead, 2013). Since reading
comprehension and critical thinking skills are essential abilities for successfully completing
Doctor of Physical Therapy (DPT) and PTA programs and the NPTE, it is relevant to focus on
the combination of these skills to predict favorable outcomes in therapy programs and on the
NPTE (Brudvig, Mattson, & Guarino, 2015; Keith, Sloas, Mooney, & Norris, 2014).
Background of the Problem
For decades, higher education programs in health care have made numerous efforts to
determine factors that will predict success rates in health care related programs. The Nelson
Denny Reading Test (NDRT) and the Health Sciences Reasoning Test (HSRT) are among the
numerous standardized tests that have been used to predict success rates in health care related
programs (Cox & McLaughlin, 2014; Haught & Walls, 2004; Jackson & Brooks, 1985). For
example, a study by Jackson and Brooks (1985) on the relationships among the Medical College
Admissions Test (MCAT) reading subtest, NDRT, and medical school achievement was
conducted. Results showed that not only was the NDRT a stronger single predictor for
2
achievement in medical school, but it was also a stronger predictor of incremental validity than
the MCAT.
Haught and Walls (2004) examined the relationships of the NDRT, MCAT, and United
States Medical Licensing Examination (USMLE) Step 1 results. They concluded that all
components of the NDRT positively correlated with the verbal reasoning score on the MCAT.
They also concluded that the vocabulary, comprehension, and reading rate portions of the NDRT
were predictors of MCAT verbal reasoning scores. Furthermore, the authors implied that a
reading component should be implemented into medical school programs to better predict
students who will be successful in medical school.
Cox and McLaughlin (2014) assessed the relationship of HSRT scores with academic and
experiential performance for the doctor of pharmacy curriculum at the University of North
Carolina at Chapel Hill Eshelman School of Pharmacy. They sought to determine the usefulness
of the HSRT for predicting the performance of students in the pharmacy program. They reported
a significant but weak correlation with the HSRT in more applied courses versus foundational
courses. They concluded that other skills that are more strongly correlated than the critical
thinking skills scores indicated by the HSRT may be more predictive of success in a pharmacy
curriculum.
Not only have higher education programs in health care been trying to determine factors
that will predict success rates in health care related programs, but these programs have also
attempted to determine variables that will predict first-time pass rates on board exams. In an
article written by Shellito, Osland, Helmer, and Chang (2010), the authors posed the question
whether it could be determined what surgery residency applicants and residents would pass the
American Board of Surgery examinations on the first attempt. These authors concluded that
3
success in residency programs and first-time pass rate predictors were based on three factors: the
student’s status in the Alpha Omega Alpha Honor Medical Society, ranking in the top one third
of the medical school class, and scores on both the USMLE Step 1 and Step 2 examinations and
the American Board of Surgery in-Training Examination.
Similarly, PT and PTA programs have also designed variables that will predict success
rates in DPT and PTA programs and on the NPTE (Cook, Engelhard, Landry, & McCallum,
2015; Sloas et al., 2013). Admission committees have attempted to select students they deemed
qualified and would succeed in PT and PTA programs based on cognitive factors, such as grade
point average (GPA), Graduate Record Examinations Test (GRE), American College Testing
(ACT), and Scholastic Aptitude Test or SAT (Desmarais, Woble-Valenski, & Oestmann, 2011;
Utzman, Riddle, & Jewell, 2007a). These programs have also used noncognitive factors, such as
interviews scores, volunteer clinic hours, and writing samples (Maring, Costello, Ulfers, &
Zuber, 2013; Shiyko & Pappas, 2009; Wheeler et al., 2018).
To become accredited or maintain accreditation, DPT and PTA programs strive to
achieve eight standards set by the Commission on Accreditation in Physical Therapy Education
(CAPTE, 2017). One standard is ultimate licensure examination pass rates. Averaged over a 3-
year period, PT and PTA programs must have an ultimate licensure examination pass rate of
80% (CAPTE, 2014a, 2014b). CAPTE also evaluates first-time pass rates. After the first quarter
of each year, first-time pass rates are published by the Federation of State Boards of Physical
Therapy (FSBPT). In 2014 and 2015, the first-time pass rate for PT candidates who attempted
the NPTE for the first time was 91% (FSBPT, 2017). In 2016, the first-time attempt rate
improved to 93% (FSBPT, 2017). In 2014, the first-time pass rate for PTA candidates who
attempted the NPTE for the first time was 86%; the rate, 84%, was slightly lower in 2015
4
(FSBPT, 2017). However, in 2016, the first-time attempt rate improved to 87% (FSBPT, 2017).
Many PT and PTA programs have aimed to attain these national percentages and have attempted
to devise predictor variables in order to reach their target goal (Arkansas State University, n.d.-b;
Aldridge et al., 2010; Keith et al., 2014).
Research on the NDRT has been conducted in the PT and PTA programs at Arkansas
State University. Aldridge et al. (2010) studied the relationship between the NDRT and the
NPTE. They investigated the relationship of scaled scores on the NDRT compared to scaled
scores on the NPTE for PT students. They concluded that there was a relationship between the
NDRT and the NPTE and that the NDRT was promising in predicting success on the NPTE. In
2013, Sloas, et al. studied the use of a pretest strategy, which included the NDRT, to predict
success on the NPTE for PTA students. The study showed that there was a weak correlation
between the verbal portion of the NDRT and the NPTE and between the comprehension portion
of the NDRT and the NPTE. There was a moderate correlation between the total composite score
on the NDRT and the NPTE. Using a multiple regression formula, the vocabulary portion of the
NDRT was most predictive of NPTE score. The study also concluded that PTA students with a
predicted score of less than 620 should seek additional assistance prior to taking the NPTE.
Huhn and Parrott (2017) investigated the relationships among the HSRT, the NPTE, and
cognitive variables. Cognitive variables included the GRE and GPA. These authors concluded
that the HSRT improved the predictor model for predicting success in a DPT program and on the
NPTE.
Little published data exists speaking to the strength of reading comprehension and critical
thinking skills as predictors of success in therapy programs and on the NPTE. Therefore, there is
a need for more research on the combined use of reading comprehension and critical thinking
5
skills for assessing the success rates in DPT and PTA programs. In addition, there is a necessity
for more research to be conducted on reading comprehension and critical thinking skills as
predictors for first-time pass rates on the NPTE for DPT and PTA students.
Statement of Problem and Research Questions
Even though many programs have very stringent admission requirements and students
with high GPAs are typically accepted into these programs, some students do not successfully
complete DPT and PTA programs. On the other hand, some students graduate from these
programs but are not successful on the NPTE on the first attempt. Because traditional academic
measures are not strong predictors, it is imperative that a strong predictor model is designed to
assist in determining success rates in programs and on the NPTE. One strategy to close this gap
in knowledge is examining reading comprehension and critical thinking skills, which may be
fundamental abilities required to matriculate through therapy programs and to achieve first-time
pass rates. Many studies have been published using the variables of reading comprehension or
critical thinking with other variables, but few have been published using these variables in
combination. For example, reading comprehension tests have been used to predict success in PT
and PTA programs and on the NPTE (Aldridge et al., 2010; Sloas et al., 2013). Critical thinking
skills assessments have also been used to predict success in PT programs and on the NPTE. For
instance, Huhn and Parrott (2017) used the HSRT to investigate the relationship among the
HSRT, the NPTE, and cognitive admission variables. Reading comprehension tests have also
been used in combination with critical thinking skills tests to predict successful matriculation
through occupational therapy programs (Mitchell & Xu, 2011). In the study by Mitchell and Xu
(2011), the NDRT and the Watson-Glaser Critical Thinking Appraisal were used to determine
reading and critical thinking ability.
6
At the time of this study, there were no studies that have used the predictor model of
NDRT, HSRT, and GPA in PT and PTA programs. Based on the limitation of research that
exists on the NDRT and HSRT in PT and PTA programs and the theoretical framework
purported for this study, the following research questions were addressed:
1. To what extent will the NDRT and undergraduate GPA (uGPA) predict success in a
DPT program?
2. To what extent will the NDRT and prerequisite GPA predict success in a PTA
program?
3. To what extent will the NDRT, HSRT, and program GPA predict the overall scores
on the NPTE for DPT students?
on the NPTE for PTA students?
Purpose of the Study
Historically, the NDRT and the HSRT have been used in combination with other
predictor variables, such as GPA, GRE, ACT, SAT, and the MCAT. Because reading
comprehension and critical thinking skills are vital in successfully matriculating through DPT
and PTA programs and passing the NPTE on the first attempt, it is worthwhile to investigate the
relationship between these variables and to determine whether these are predictor variables for
success rates in programs and on the NPTE (Aldridge et al., 2010; Brudvig et al., 2015; Huhn &
Parrott, 2017; Keith et al., 2014; Sloas et al. 2013). The purpose of this study was to determine
whether a reading test and GPA could predict success in a DPT and PTA program. This study
also attempted to determine whether a reading test, a critical thinking test, and GPA would
predict first-time pass rates on the NPTE.
7
This quantitative study used a convenience sample of DPT and PTA students at Arkansas
State University. This study examined the relationship between the predictor variables, NDRT,
HSRT, and GPA. Not only did this study explore whether the NDRT and uGPA could predict
success in a DPT program, but this study also investigated the NDRT and prerequisite GPA to
determine if these variables could predict success in a PTA program. In addition, this study
evaluated the results of the NDRT, HSRT, and program GPA (pGPA) to determine if these
variables could predict first-time success for DPT and PTA students on the NPTE. Because
student and program success can be impacted by attrition and NPTE pass rates, it was relevant to
determine whether these variables were highly correlated with and could predict success rates in
therapy programs and first-time pass rates on the NPTE.
Significance of the Study
Before licensure is obtained, DPT and PTA students must graduate from a DPT or PTA
program and successfully complete the NPTE. In order for students to accomplish both tasks,
they must possess good reading and critical thinking skills and, thus, be able to make sound
clinical decisions. This study was designed to assess the reading ability, critical thinking skills,
and GPA of DPT and PTA students. If assessment of these skills can be evaluated prior to
students taking the national board exams, students who score below average on the NDRT and
HSRT can benefit by engaging in early intervention programs to improve their reading
comprehension and critical thinking skills. Assessment completed prior to students matriculating
through the programs could also increase the likelihood of success in DPT and PTA programs
and on the NPTE. Early intervention could potentially save students money and time and
increase the likelihood of success in educational programs and on national board examinations.
8
Definitions of Terms
For the purpose of this quantitative research study, the following definitions were used:
Critical thinking skills. This term describes the process of making judgments that go
beyond memorizing and recalling information.
Grade point average (GPA). GPA or the average grade earned by a student is calculated
by dividing the total number of grade points earned by the total number of credits attempted.
The Health Sciences Reasoning Test. The HSRT is a critical thinking test written
specifically for health care. Questions are set within a health care context. The test is a multiple-
choice test that is administered within 45 to 50 minutes. The test contains five subscale critical
thinking areas: analysis and interpretation, inference, evaluation and explanation, deductive
reasoning, and inductive reasoning.
National Physical Therapy Licensure Examination (NPTE). The NPTE is a national
board examination that is administered by the Federation of State Boards of Physical Therapy
(FSBPT) and given in each state. The NPTE assesses basic entry-level competence of PT and
PTA candidates who have been approved for testing from an accredited program. The NPTE is a
conversion of raw scores to a scale score ranging from 200 to 800 with a passing score of 600.
The Nelson Denny Reading Test (NDRT). The NDRT is a standardized reading test
that measures the reading ability of high school and college students. It consists of vocabulary
and comprehension sections. The vocabulary portion has 80 multiple-choice questions with five
possible answer choices. Fifteen minutes are allowed for the completion of this portion of the
exam. The comprehension portion consists of seven passages from which students must answer
38 multiple-choice questions with five answer choices based on content of those reading
passages. Students are given 20 minutes to complete this portion of the exam.
9
Reading ability. This term describes the cognitive process of word recognition,
comprehension, and fluency.
Assumptions, Limitations, and Delimitations of the Study
One major assumption can be made regarding students and testing for the NDRT and
HSRT. It can be assumed that students will perform to the best of their ability when completing
the NDRT and the HSRT. However, because there is no immediate incentive, such as an
examination score for a specific course, some students may not perform as well as they would if
they knew that these examinations were linked to a particular course grade.
The major limitation of this study was the sampling process. Subjects were selected from
a convenience sample from an accessible population at Arkansas State University. DPT and PTA
students were selected from the graduating classes of 2017 and 2018. Even though efforts were
made to adequately represent the population of DPT and PTA students nationally, caution should
be used when evaluating the findings of this study because of the sampling process.
One delimitation of this study was the selection of associate- and graduate-level students
from Arkansas State University. Prediction of first-time pass rates on the NPTE for DPT and
PTA students at Arkansas State University was limited to GPA and two standardized tests, the
NDRT and the HSRT. Another delimitation of this study was the administration of the
standardized tests. The NDRT and HSRT were administered at a time of convenience. The
HSRT was administered to the DPT and PTA class of 2018 on two occasions; this administration
could have resulted in practice effects. Subject effect was also another possible delimitation.
Students might have performed better on the HSRT if the test had been administered prior to
their clinical rotations. Furthermore, experimenter effects could be possible since the researcher
10
was a professor in the DPT program; DPT students are more familiar with test administration
from the researcher than are PTA students.
11
CHAPTER 2
REVIEW OF LITERATURE
This chapter will begin by outlining student requirements, summarizing qualifications,
and discussing and defining skills. Next, identifying predictor models for student success in
numerous disciplines and therapy programs will be discussed. Lastly, predictor models for
success on the board examinations of various disciplines and National Physical Therapy
Examinations (NPTE) will be discussed.
PT and PTA Requirements and Qualifications
Candidates for both Doctor of Physical Therapist (DPT) and physical therapy assistant
(PTA) programs must commit their time, make monetary investments, and meet educational
requirements. Physical therapist assistant (PTA) candidates must be dedicated to completing
prerequisite courses to apply for PTA programs. These prerequisite courses generally take 1 year
to complete. After prerequisites are completed and PTA candidates are accepted into PTA
programs, candidates can expect to take 1 year to complete most PTA programs. Along with
taking prerequisite courses, a baccalaureate degree is required for DPT candidates. Once DPT
candidates have been admitted into DPT programs, they are typically enrolled in a program for 3
years.
Becoming a PTA or DPT can be a costly endeavor because of the expenses that are
accumulated by candidates. While PTA candidates have costs associated with the completion of
12
prerequisite courses and PTA school, DPT candidates have expenditures associated with
prerequisite courses, a baccalaureate degree, and DPT school. According to the American
Physical Therapy Association (APTA), the mean annual costs for public in-state PTA programs
during the 2018-2019 school term was $12,589 and $38,922 for private programs (Commission
on Accreditation in Physical Therapy Education, 2018a). In the 2018-2019 school term, the mean
annual tuition and fees were reported as follows for DPT programs. While public in-state
programs were $65,170, private programs were $112,714 (Commission on Accreditation in
Physical Therapy Education, 2018b).
“The purpose of PTA education is to graduate knowledgeable, competent, self-assured,
adaptable, and service-oriented patient/client care providers” (American Physical Therapy
Association, 2015c, para 2). The mission of PT education is similar to that of PTA education:
The mission of PT professional education is to graduate knowledgeable, service-oriented,
self-assured, adaptable, reflective practitioners who, by virtue of critical and integrative
thinking, lifelong learning, and ethical values, render independent judgments concerning
patient/client needs that are supported by evidence; promote the health of the patient or
client; and enhance the professional, contextual, and collaborative foundations for
practice. (American Physical Therapy Association, 2015b, para. 2)
The first step to becoming a licensed PTA or DPT is to successfully complete a PTA or DPT
program and graduate from an accredited program. The Commission on Accreditation in
Physical Therapy Education (CAPTE) assures that students have a solid educational background
and grants accreditation to qualifying programs. CAPTE provides students with program options
that meet their learning needs, affords institutions with funding opportunities, ensures the public
that programs are meticulously evaluated, and gives practitioners, teachers, and students the
13
opportunity to collaborate to improve future endeavors of the profession (Commission on
Accreditation in Physical Therapy Education, 2017).
With approval from their accredited programs, candidates are allowed to sit for the
NPTE. The NPTE is a computer-based examination that is administered by the Federation of
State Boards of Physical Therapy (FSBPT).
The NPTE for the PTA assesses entry-level competence for the safe provision of
procedural interventions. The NPTE is “competency specific” and covers the entire scope
of practice, which for the PT includes theory, examination and evaluation, diagnosis,
prognosis, treatment, intervention, prevention, and consultation that are consistent with
the examination blueprint. (American Physical Therapy Association, 2015a, para. 5)
The examination consists of four sections with 50 questions for PTA candidates. Only 150
questions of the 200 are scored, and the other 50 questions are pretested for future board
examination questions. For DPT candidates, there are five sections with 50 questions. Only 200
of the 250 questions are scored, and the other 50 questions are pretested for future board
examination questions. Candidates are given one 15-minute scheduled break; however,
candidates are allowed to take up to three unscheduled breaks between sections using the time
allotted for the examination. The score ranges from 200-800 with a passing score of 600 for both
PTA and DPT candidates. “The passing score established for the National Physical Therapy
Licensure Examinations (NPTE) reflects the level of performance requirements to provide
minimally safe and competent physical therapy services by physical therapists and physical
therapist assistants” (Federation of State Boards of Physical Therapy, 2017, para. 1).
14
PT and PTA Skills
Graduating from an accredited program is the first step in the licensure process.
Successfully passing the NPTE is the second step that enables candidates to seek licensure. In
order to get to this point of achievement, candidates must possess certain abilities, such as
proficient reading comprehension and critical thinking skills.
Reading comprehension. Reading comprehension is one skill that DPT and PTA
students must possess. Reading comprehension can be measured by using the Nelson Denny
Reading Test (NDRT). Before discussing studies related to the NDRT, factors, such as the
reliability, validity, and new norms, should be mentioned.
Important factors related to the reliability, validity, new norms, and academic
levels of reading comprehension. Reliability of the NDRT was cited by Jackson and
Brooks in 1985. These authors cited split-halves reliability coefficients from J. I. Brown, Nelson,
and Denny’s (1973) manual as follows: 0.91 for vocabulary, 0.74 for comprehension, and 0.90
for the total score. Reading rate alternate-form’s reliability was 0.66.
The validity of the NDRT has been questioned. Stevens (1980) examined the NDRT to
determine whether prior knowledge of a topic would affect reading comprehension. Concurring
with other authors, Stevens determined that reading can be improved by having a prior
knowledge of the subject.
On the other hand, Jackson and Brooks (1985) conducted a study on 292 students
entering the University of Alabama School of Medicine in 1978 and 1979. They used four
criterion variables: basic science GPA, clinical science GPA, and total scores on Part 1 and Part
2 of the national Board of Medical Examiners. They found that the NDRT total score was a
better predictor for criterion variables and for incremental validity than the MCAT reading score.
15
Coleman, Lindstrom, Nelson, Lindstrom, and Gregg (2010) examined content validity.
Two hundred fifty-three college students who were not at risk for learning disabilities and 26
college students who were at risk for learning disabilities were examined to determine the
content validity of the comprehension portion of the NDRT using Forms G and H. These
students were asked to answer questions on the comprehension section without reading the
passage. Students had higher scores on hard science passages (46.7%-56.6%) and lower scores
on humanities passages (30.7-37.4). A statistically significant differences in overall accuracy was
shown between the Form H typical group (46.6%) and the at-risk group (40.6%). These results
prompt questions about whether the comprehension section of the NDRT is measuring reading
disabilities because at-risk students scored nearly as well as typical students.
Reading comprehension has been used as a variable to compare students in different
degree level programs. In a retrospective design, Mitchell and Xu (2011) compared the critical
reasoning of 215 students, who were entering a bachelor of occupational therapy (OT) program
or an entry-level master of OT program, at the University of Tennessee Health Sciences Center.
The bachelor of OT program consisted of four classes, and the entry-level master of OT program
was comprised of five classes. Grade Point Average (GPA) was an independent variable. The
following instruments were used: NDRT and Watson-Glaser Critical Thinking Appraisal
(WGCTA). The subscales are inference, recognition of assumptions, deduction, interpretation,
and evaluation of arguments. Multivariate analysis of covariance indicated that there was a small
statistically significant difference between the groups’ critical reasoning scores. Univariate
analysis revealed that even though effect size was small, groups differed with recognition of
assumptions on the WGCTA, with bachelor’s-level students scoring higher than master’s-level
students. The differences that were noted among the groups did not depend on GPA or reading
16
comprehension. There are three possible explanations for the results of this study. One
explanation is that the applicant pool for the bachelor’s-level program was larger than the pool
for the master’s-level program; hence, there was greater selectivity for applicant acceptance.
Another possible explanation was that the prerequisites may not have effectively promoted
critical reasoning. A third explanation is that the WGCTA might not be sensitive enough to
differences in the critical reasoning abilities of OT students. Because the results of this study
indicated that bachelor’s-level students scored higher than master’s-level students, reflection
should occur prior to transitioning programs from master’s-level degrees to the doctoral level.
Because there were few studies performed using the NDRT outside of the United States,
Masterson and Hayes (2004) evaluated 197 undergraduate students from the University of Essex
in the UK to determine whether the type of degree and the year of study were influenced by
reading ability. Fifty-one students having a science-based degree had a mean scaled score of
238.1. Ninety-five humanities students had a mean scaled score of 239.6, and 51 social science
students had a mean score of 235.7. With a reading rate of 283.2, students in humanities read
faster than students in social science (247.4) and science (243.3). There was no significant
difference noted for vocabulary, comprehension, or total NDRT scores among the different
degrees. Students in their first year of study had a mean score of 234.0. Students in their second
year of study had a mean score of 240.3, and students in their third year of study had a mean
score of 237.1. Vocabulary scores were significantly different for the second and first year of
study with students in the second year of study scoring higher than students in the first year of
study. Even though the comprehension section was not significant for year of study, second year
of study scores were higher than first. There was no significant difference noted for reading rate
for the effect of year of study. These results indicated that students who majored in humanities
17
read faster than students from science and social science, and students who were in their second
year of study had higher total mean scaled scores for NDRT Form G.
Norms have been developed on the NDRT for healthcare professionals. In order to
compare the raw scores of high school and 4-year college to healthcare professional students,
Haught and Walls (2002) examined and converted raw scores on Forms G or H of the NDRT for
healthcare professional students. Using normative data, the raw scores were converted into
percentile rank, standard, grade equivalent, and stanine scores for 1,122 first-year medical,
dental, DPT students, and internal medicine interns at West Virginia University. Normative data
are located in the NDRT manual for Scoring and Interpretation. Healthcare professional students
scored higher on all sections of the NDRT. Medical students and interns scored higher on
reading rate compared to 4-year college graduates. This information demonstrates that not only
do vocabulary and comprehension continue to improve during postsecondary education, but
reading continues to improve with additional education. Perhaps, the students who are admitted
into the professional programs have better skills in these areas.
Reading comprehension and academic success. From education to health care, the
importance of reading comprehension skills and academic success has been documented in
several sources. In a quantitative ex post facto study, a random sampling of 30 records was used
to determine the success of an undergraduate teacher preparation program. To determine the
success of the program, the following variables were used: the NDRT, entrance GPA of 2.75 or
greater, and basic skills assessment scores for reading, writing, and math. Results indicated that
the success of candidates was based on the final GPA. A predictor model was developed and
used to determine that the combination of the predictor variables could forecast the likelihood of
success for teacher candidates (Texas, Mundy, Varela, Ybarra, & Yuma, 2016).
18
Chambers, Munday, Sienty, and Justice (1999) completed a pilot study on 116 subjects at
Texas A & M University to determine the effects that specific variables had on teachers’
performance on the Professional Development parts of the Examination for the Certification of
Educators in Texas (ExCET). The following variables were used: age; gender; GPA; math,
reading, and writing scores on the Texas Academic Skills Program, critical thinking abilities as
measured by the Cornell Critical Thinking Test, and reading ability as measured by the NDRT.
They concluded that critical thinking subset scores alone and the combination of these
independent variables could predict success on the Professional Development parts of the
ExCET. Based on the authors’ conclusion, critical thinking should be implemented into
programs.
Critical thinking skills, clinical reasoning skills, and clinical decision making.
Adapting to a shifting scope of practice, providing quality care in an interdisciplinary
environment, and treating patients with multiple comorbidities are the situations that PTs and
PTAs encounter on a daily basis. The use of critical thinking is a vital skill that these PTs and
PTAs must possess to be competent and autonomous practitioners who make sound clinical
decisions (American Physical Therapy Association, 2015c, para. 2). Critical thinking can be
operationally defined in several ways, but the American Philosophical Association (APA)
developed a workable definition that has been used nationally:
We understand critical thinking to be purposeful, self-regulatory judgment which
results in interpretation, analysis, evaluation, and inference, as well as explanation of the
evidential, conceptual, methodological, criteriological, or contextual considerations upon
which that judgment is based. CT is essential as a tool of inquiry. As such, CT is a
19
liberating force in education and a powerful resource in one's personal and civic life.
(Facione & Facione, 1996, p. 2)
Critical thinking skills and clinical reasoning skills are synonymous in the field of
physical therapy. Huhn, Black, Jensen, and Deutsch (2013) outlined the three factors involved in
clinical reasoning. The first factor includes a therapist’s contextual factors, such as the life
circumstances and clinical experiences. The second factor encompasses the therapist’s cognitive
factors, such as critical thinking and metacognition skills. The last factor, the patient’s contextual
factors, consists of life circumstances and the health of the patient.
Using three PT cohorts and one cohort of PT interns, Brudvig, Macauley, and Segal
(2017) recognized the relevance of critical thinking and clinical decision making in the physical
therapy profession and decided to validate a 25-item survey tool. The 25-item survey tool was
adapted from the PT Clinical Performance Instrument (CPI) to measure clinical decision making
and clinical skills for all practice PT settings (Brudvig & Macauley, 2015). The tool
demonstrated internal consistency, construct validity, and face validity.
In an article written by Gilliland (2014), the difference in the developmental level of
critical thinking skills and clinical reasoning was demonstrated. Clinical reasoning was compared
in a random sample of six first-year students at the beginning of their second semester and six
third-year students during their final semester of class. Critical thinking and clinical reasoning
differed in first- and third-year students. The abilities demonstrated by third-year students were
more similar to novice clinicians when formulating hypotheses, making assessments, and
selecting treatments. Based on the results of this study, programs should promote effective
critical thinking skills and clinical reasoning by incorporating multiple teaching methods, such as
problem-based learning, self-assessment, and experiential learning. Due to the small sample size
20
of this study, caution should be used when attempting to apply these results to the general
physical therapy student population.
Critical thinking skills and academic success in health care professions. Possessing
critical thinking skills is a valuable asset for health care professionals. In a descriptive and
exploratory research study, the critical thinking skills of 57 graduating seniors in the class of
2011 from the University of Tennessee Health Science Center in Memphis were examined by
Sharp, Reynolds, and Brooks (2013). The allied health programs that were included were
cytotechnology, health informatics and information management (HIIM), dental hygiene, and
medical technician. Variables included age, gender, GPA, program, academic level, and
educational degree seeking. Results demonstrated that 64.9% of the students had weak, 31.6% of
the students had moderate, and 3.5% of the students had strong critical thinking skills. Entry-
level master’s-level students had the strongest critical thinking skills followed by master’s-level
and baccalaureate-level students respectively. There was a significant difference for different
program types and academic levels. Differences were noted for dental hygiene (M = 7.73) and
the following groups: cytotechnology (M = 19.50) and HIIM (M = 18.68). Differences were
noted for HIIM (M = 18.68) and medical technology (M = 10.33). Differences were also noted
for medical technology (M = 10.33) and cytotechnology (M = 19.50). The results of this study
allowed faculty to assess critical thinking ability and design program curricula with the intent to
strengthen the critical thinking skills of their students.
In a study by Cox and McLaughlin (2014), 122 admitted candidates at North Dakota
South University were evaluated to determine whether the Health Sciences Reasoning Test
(HSRT) would impact the admissions process and how impressionable would the HSRT be if it
indeed influenced the admissions process. The following variables were used: Pharmacy College
21
Admission Test (PCAT) cumulative percentage score, PCAT essay score, student core course
GPA, HSRT cumulative score, and interview score. Cox and McLaughlin concluded that even
though the HSRT was a good test to evaluate critical thinking skills, scores on the HSRT are
redundant with cumulative PCAT scores as an admission screening tool.
To determine whether there was a relationship between the HSRT and pharmacy student
admission variables, 329 first-year pharmacy students were examined (Cox, Persky, & Blalock,
2013). These students took the HSRT between 2007 and 2009 at the University of North
Carolina Eshelman School of Pharmacy. Variables included the HSRT, undergraduate grade
point average (uGPA), PCAT scores, previous degree, and gender. There was an association
between the HSRT and the reading comprehension (r = 0.38, p < 0.001), verbal (r = 0.40, p <
0.001), and quantitative (r = 0.19, p < 0.001) subsections of the PCAT. The model accounted for
27.4% of the variance in HSRT scores. This variance suggests that the HSRT can assess beyond
norm admission criteria. This study also suggests that the PCAT can measure some critical
thinking aspects.
The same students in the above study by Cox et al. (2013) were studied by assessing the
relationship between academic experiential performance and the HSRT (Cox & McLaughlin,
2014). Academic experiential performance consisted of 29 courses that were completed
throughout the semester and advanced pharmacy practice experiences (APPEs). Courses were
categorized as basic sciences, therapeutics, Pharmaceutical Care Laboratories (PCL), and other.
All of the correlations were significant but positive and low. The courses that were strongly and
significantly correlated with overall HSRT and its subscales were courses in Law and Ethics rp =
.027 and PCL 3 rp = .026. The correlation between Law and Ethics and deduction was rp = .025;
the correlation between PCL 3 was rp = .026, and PCL 3 and induction were correlated rp = .023.
22
There was a correlation in applied courses. Because of the weak correlation between the HSRT
and variables, the HSRT may be limited in its predictive abilities regarding the success of
students.
There were two studies completed in nursing that suggested that correct nursing
diagnoses are dependent on critical thinking skills. In a factorial design using 249 nurses,
knowledge sources and a predefined record structure were utilized to determine their effects on
the accuracy of nursing diagnoses (Paans, Sermeus, Nieweg, Krijnen, & van der Schans, 2012).
A knowledge inventory, the California Critical Thinking Disposition Inventory (CCTDI), and the
HSRT were the three questionnaires that were used. Nursing diagnoses were significantly higher
when using a predefined record structure, which accounted for 47% of the variance in the
accuracy of nursing diagnoses when combined with a nurse’s age and the reasoning skills of
deduction and analysis. Strong scores on the HSRT in analysis, inference, and deduction were
notable for nurses who made more accurate diagnoses. The accuracy of nurses’ diagnoses was
improved by the use of a predefined record structure and positive temperaments of nurses
regarding critical thinking and reasoning skills.
A second study in nursing suggested that correct nursing diagnoses are dependent on
critical thinking skills (Paans, Sermeus, Nieweg, & van der Schans, 2010). To determine whether
knowledge sources, ready knowledge, and attitude toward critical thinking and reasoning skills
influenced the accuracy of nursing students’ diagnoses, 100 students from a bachelor of nursing
program at Hanze University in Groninger, Netherlands were examined. The variables that were
included were D-Catch knowledge inventory, CCTDI, HSRT, and case scenarios, which were
assessed for script consistency, specificity, and medical correctness. Students were unable to use
knowledge sources and did not use reasoning skills efficaciously. Knowledge source only had a
23
small effect on the accuracy of nursing students’ diagnoses, but the analysis domain of the HSRT
was the only variable that was significantly (p = .013) related to accuracy. This study
demonstrated that the analysis component of critical thinking is valuable in making accurate
nursing diagnoses, which can be accomplished by students using knowledge source and
reasoning skills.
Critical thinking skills and academic success in physical therapy. The Health Sciences
Reasoning Test (HSRT) has also been used in disciplines other than pharmacy and nursing. The
HSRT has been identified as a valid test that can be used to assess critical thinking ability in PT.
Using 73 PTs with clinical specialty certifications and 79 first-year PT students from two PT
programs, Huhn, Black, Jensen, and Deutsch (2011) evaluated the construct validity of the
HSRT. First-year students were from a private Midwestern university and a public East coast
university. The clinical specialists were certified in geriatrics, neurology, and orthopedics. As
indicated by a t test and one-way analysis of variance (ANOVA), that there were no differences
between schools or specialties. The results for students were as follows: M = 22.49 and SD = 3.2.
The results for expert PTs were as follows: M = 24.06 and SD = 3.92. There was a significant
difference noted for the deductive F (1,150) = 5.96, p = 0.01 and analysis F(1,150) = 12.94, p <
0.001 portions of the HSRT; this difference successfully discriminated between students and
expert PTs. Construct validity was established because the HSRT successfully discriminated
between the critical thinking abilities of first-year students and clinical specialists. The HSRT
can be beneficial for students and educators when determining student weaknesses in critical
thinking and developing student remediation to improve critical thinking skills.
Huhn et al. (2013) also evaluated change in critical thinking skills. Using 37 students
from a public East Coast university and 26 students from a private Midwest university, these
24
authors evaluated change in critical thinking by allowing students to complete the HSRT upon
entry into the program, prior to final affiliations, and prior to graduation. There was a statistically
significant difference, which occurred between the first and second test, for the overall HSRT
score, the deductive subscale, and the analysis subscale. There was also a statistically significant
difference (F1 = 12.65; p < .05) noted between the two programs with the Midwest’s mean score
(24.85) being higher than the East Coast’s mean score (22.42). These results indicated that the
greatest amount of change in critical thinking occurred during the teaching or classroom portion
of the program and not the clinical portion. Not only does the HSRT appear to be valid and
measure change in critical thinking scores, but it also appears to be a beneficial assessment tool
for PT students.
In a repeated measures design, the acquisition and development of critical thinking skills
and the relationship between learning styles and critical thinking were evaluated in 18
internationally trained PT students from India (Brudvig et al., 2015). These students were in a
post-professional Master of Science in PT education program in 2011 to 2012 in the northeastern
region of the United States. These students completed the Kolb Learning Style Inventory (KLSI).
These 18 students were tested on the HSRT three times in the first year: upon entry, after the first
two academic semesters, and after the third semester. The following teaching strategies were
implemented within the PT program: Schӧn’s reflective practice and Bandura’s social cognitive
theory. The means for Test 1, Test 2, and Test 3 were as follows: 21.39, 18.94, and 23.59
respectively. Kolb’s learning style, abstract conceptualization, and higher HSRT scores were
positively related (r = .70, p = .01). For these 18 students, critical thinking acquisition did occur
over the 1-year period in a curriculum that incorporated multiple social learning strategies and
self-reflection.
25
Brudvig, Mattson, and Guarino (2016) also evaluated 61 doctoral-level students to track
the development of critical thinking skills and determine the relationship between learning styles
and critical thinking skills. In a quasi-experimental design, learning styles were assessed using
KLSI and critical thinking was assessed using the HSRT. Both the KLSI and HSRT were given
at the beginning of the program. The HSRT was also completed on three additional occasions:
after the first three semesters; before the start of the clinical experience, following the 10-week
clinical experience at the end of the summer of the first academic year; and halfway through the
year-long internship. Students exhibited 7 out of 9 learning styles. In using the HSRT to assess
critical thinking, the most significant change was noted between the first (M = 23.26) and fourth
assessments (M = 24.57). Scores on the HSRT on the first assessment and fourth assessment
indicated a significant improvement in the subscales of deduction (M = 7.38 and 8.54) and
inference (M = 3.29 and 4.46), but a ceiling effect was shown for induction, evaluation, and
analysis. This result indicated that the HSRT is a good tool for assessing deduction and inference
but not for induction, evaluation, and analysis. Although the correlations were weak, there was
not only a relationship between critical thinking skills and abstract conceptualization but also
between abstract conceptualization and concrete experimentation. It can be concluded that
students who are a part of a cohort with particular learning styles can benefit throughout the
program and may adapt better in the health care environment. The HSRT has proven to be a
valuable assessment tool to assess critical thinking skills throughout the progression in a
doctoral-level PT program and may be a good assessment tool for clinical reasoning and clinical
decision making.
26
Predictive Studies Regarding Testing Accommodations
An increased likelihood of student success has been demonstrated on examinations with
the use of testing accommodations, such as extending time on examinations and testing in a
separate room. Extended time has been demonstrated to improve reading comprehension test
scores for students with disabilities in middle school, secondary education, and postsecondary
education. T. E. Brown, Reichel, and Quinlan (2011) investigated 145 adolescents between the
ages of 13 to 18 with DSM-IV ADHD and no specific reading disorder. With a 35.1% increase
in their score for standard time versus extended time, students scored within one standard
deviation of their verbal comprehension index when they were given extended time on the
NDRT.
According to the U. S. Department of Education, the Rehabilitation Act of 1973, Section
504, Subpart E, mandated postsecondary education programs to provide equal access to
educational opportunities to qualified persons with disabilities (U. S. Department of Education,
2000). Runyan (1991) examined 16 students with learning disabilities and 15 normally achieving
students attending the University of California to determine the effect of extra time on the NDRT
(Forms E and F) and Reading Rate Test. Students with learning disabilities scored significantly
lower on timed conditions but scored as well as normally achieving students when given extra
time. This study demonstrated that performance improves for students with disabilities when
they are given the accommodation of extended time.
The need for testing accommodations on the NPTE has increased rapidly from 2000 to
2009. In 2000, the total number of NPTE examinations given to PTs was 11,915. Of the 11,915
examinations given, there were 62 candidates or 0.52% of the population who required testing
accommodations. In 2000, the total number of NPTE examinations given to PTAs was 5,543. Of
27
the 5,543 examinations given, there were 40 candidates or .72% of the population who required
testing accommodations. For both PTs and PTAs, the number of candidates needing
accommodations in 2009 as compared to 2000 more than doubled. In 2009, the total number of
NPTE examinations given to PTs was 12,591. Of the 12,591 examinations given, there were 157
candidates or 1.28% of the population who required testing accommodations. In 2009, the total
number of NPTE examinations given to PTAs was 5,641. Of the 5,641 examinations given, there
were 106 candidates or 1.88% of the population who required testing accommodations. There
was a difference in 10-year pass rates between accommodated candidates for PTs (17%) and for
PTAs (12%). Because of the results on the NPTE, testing accommodations should be sought as
early as possible as students matriculate through their respective programs. Ingram, Mohr, and
Mabey (2015) concluded that early detection is vital for student success in PT and PTA
programs and on the NPTE.
Predictive Studies in Health Care
Many disciplines have evaluated cognitive variables as predictors of first-time pass rates
on national board exams (Higgins, 2005; Solberg, 2015; Spurlock & Hunt, 2008). Some
disciplines have evaluated cognitive and noncognitive factors as predictors of first-time pass
rates on national board exams (Middlemas, Manning, Gazzillo, & Young, 2001; Sanderson &
Lorentzen, 2015; Shellito et al., 2010). A few of the disciplines that have investigated first-time
pass rates include dental hygiene, medical laboratory science, emergency medical technician
(EMT), physician assistant, medical doctors, nursing, athletic training, and occupational therapy.
Predictive study in the discipline of dental hygiene. In an exploratory and descriptive
design study, Sanderson and Lorentzen (2015) surveyed 139 dental hygiene chairs and program
directors to determine the association of admission variables and first-time pass rates on the
28
dental hygiene licensure examination. Piloted for readability and validity, the survey was tested
by five dental hygiene faculty from different academic institutions. The survey consisted of 18
questions, which included questions regarding program demographic information, admission
requirements, and pass rates on the National Board Dental Hygiene Examination (NBDHE) and
regional clinical board exam. Admission variables, such as GPA, American College Testing
(ACT), manual dexterity tests, letters of recommendation, and previous dental experience, were
used. After analysis was completed, there was no statistically significant variable that predicted
first-time pass rates on the dental hygiene licensure examination. As a result of these findings, it
was concluded that further research is needed to determine valid and reliable admission
standards for dental hygiene programs and create predictor variables for the NBDHE and
regional clinical board exam.
Predictive study in the discipline of medical laboratory science. From 2009 to 2012,
Solberg (2015) investigated the critical thinking skills of 96 applicants using a critical thinking
exercise (CTE) to predict success on the American Society for Clinical Pathology (ASCP) Board
of Certification (BOC) examination for the medical laboratory science category. The CTE was
included as a part of the application process. Other variables consisted of undergraduate GPA,
science GPA (SGPA), and overall and subsection ASCP BOC exam scores. There were weak to
moderate positive relationships with the independent variables and ASCP BOC exam scores.
With a 1.3% mean variance explained by the model, there was a weak, positive nonstatistically
significant relationship (r = 0.113) between CTE and ASCP BOC exam scores. There was also a
weak positive relationship (r = 0.029-0.175) between the CTE and exam subsections. A
moderately positive relationship (r = 0.358) existed between GPA and ASCP BOC performance.
A statistically significant difference was noted with the model explaining 12.8% of the mean
29
variance. Having a moderately positive relationship (r = 0.428), the SGPA model was also
statistically significant and explained 18.3% of the mean variance. The author concluded that
critical thinking abilities may predict clinical performance and strengthen predictor models, such
as models that include GPA.
Predictive study in the discipline of emergency medical technician. The relationship
of the Emergency Medical Technician-basic (EMT-B) examination score, the length of the
EMT-B certification, and first-time pass rates on the National Paramedic Certification
Examination (NPCE) were assessed (Fernandez, Studnek, & Cone, 2009). Data were used from
the National Registry of EMT to assess individuals who had taken the NPCE less than two years
after completing the paramedic course. Individuals from 14 states took the NPCE between
January 1, 2002, and December 31, 2006. Independent variables included age, race, sex, years of
education, elapsed time since paramedic course completion, and paramedic program national
accreditation status. A good fit was shown by the multivariable logistic regression model (p =
0.62) between performance on the EMT-B certification examination, length of EMT-B
certification, and first-time pass rates on the cognitive portion of the NPCE. Since the EMT-B
certification examination and length of EMT-B certification examination are associated with
first-time pass rate success on the NPCE, these two variables should be considered when
determining admission standards and program resource allocation.
Predictive study in the discipline of physician assistant. Predictor studies in the
physician assistant discipline have also been conducted. In a study that was conducted from 2007
to 2009, 47 students at Chatham University were evaluated as a means to improve prediction of
student performance on the Physician Assistant National Certifying Examination (PANCE) by
using multiple variables (Ennulat, Garrubba, & DeLong, 2011). Physician Assistant Clinical
30
Knowledge Rating and Assessment Tool (PACK RAT), overall GPA, prerequisite GPA,
multiple-choice question examinations given throughout the year, and a summative examination
were the independent variables used to predict pass rates on the PANCE. The multiple-choice
question examinations and the summative examination were internally consistent and reliable.
With the PACK RAT being the most significant, Pearson correlation analysis revealed positive
linear relationships with the five predictor measures and the PANCE. Using stepwise
discriminant analysis, the PACK RAT was the only predictor variable that was significant in the
final predictor model. According to discriminant analysis, the PACK RAT, multiple-choice
question examinations, and summative exam were shown to better discriminate between students
who would pass or fail the PANCE. Furthermore, regression analysis revealed that the multiple-
choice question examinations and summative examination were better predictors of students who
were at risk of failing the PANCE. In conclusion, the multiple-choice question examinations and
summative examination can predict students who are at risk of not being successful on the first
attempt of taking the PANCE; these examinations could alert faculty to intervene early with
students.
Predictive studies in the discipline of medicine. Medical school success and first-time
pass and failure rates have been predicted for medical examinations. Haught and Walls (2004)
evaluated 730 students to determine if there was a relationship between scores on the NDRT,
Medical College Admission Test (MCAT), and the United States Medical Licensing
Examination (USMLE) Step 1. Results indicated that the significant predictors of MCAT verbal
reasoning scores were vocabulary, comprehension, and reading rate. The NDRT total and MCAT
verbal reasoning correlation was r = 0.56, p < .01. The correlation between the NDRT total and
the USMLE was r = .13, p < .01, and the correlation between the vocabulary portion of the
31
NDRT and the USMLE was r = 0.14, p < .01. The vocabulary portion of the NDRT was a
significant predictor of USMLE Step 1 score. This study showed that including a reading test,
such as the NDRT, into medical programs can assist in predicting students who will be
successful in medical school.
In the late 1970s, a new version of the MCAT was administered to students entering
medical school. Many investigations began to determine whether there was a predictive
difference between the examination versions of the MCAT. Using students from Wright State
University School of Medicine, Markert (1985) investigated the relationship of old MCAT and
new MCAT scores to determine if these scores could predict success on the National Board of
Medical Examiners (NBME). Fifty-nine students who took the old MCAT version and 46
students who took the new MCAT version were evaluated. On the old MCAT, a significant
positive correlation (r = .32, p = .006) was shown for Verbal Ability subtest scores and the
NBME. On the new MCAT, a significant positive correlation (r = .35, p = .009) was not only
shown for Skills Analysis: Reading subtest scores and the NBME, but also a positive correlation
(r = .31, p = .019) was demonstrated for Skills Analysis: Quantitative subtest. Stepwise multiple
regression showed that there was only one predictor subtest in the regression model. With p =
.01, verbal ability was the predictor subtest for the old MCAT. With p = .02, Skills Analysis:
Reading was the predictor subtest for the new MCAT. Interpretation of these results indicated
that basic learning skills can predict success rates on the NBME Part III. These results can be
very valuable to educators, especially when being selective of students during the admission
process.
To evaluate reading ability and MCAT performance and to predict medical school
achievement, Jackson and Brooks (1985) studied 292 students from 1978 to 1979 who were
32
entering classes at the University of Alabama School of Medicine. GPA, clinical SGPA, basic
SGPA, and total score on Parts I and II of the NBME were the four criteria variables included in
this model. There was a correlation between MCAT reading scores and NDRT: vocabulary r =
.44, comprehension r = .48, total r = .51, and reading rate r = .09. MCAT biology and NDRT
total correlation was r = .38. The total score on the NDRT was a better predictor than MCAT
reading score for all criterion variables for academic achievement and on the NBME
examination.
In an article written by Shellito et al. (2010), the authors posed the question of whether it
could be determined which surgery residency applicants and residents would pass the American
Board of Surgery examinations on the first attempt. These authors concluded that success in
residency programs and first-time pass rates predictors were status in the Alpha Omega Alpha
Honor Medical Society, ranking in the top one third of the medical school class, and scores on
both the USMLE Step 1 and Step 2 examinations and the American Board of Surgery in-
Training Examination.
In a retrospective study using 17 residency programs in the western United States,
607 residents who graduated in 2000 to 2007 were evaluated to determine whether certain
variables would predict successful performance on the American Board of Surgery (ABS)
qualifying and certifying examinations (De Virgilio et al., 2010). The following variables were
used in the predictor model: United States versus non-United States medical school graduation,
the USMLE Step 1 and 2 scores, ABS In-Training Examination (ABSITE) score, operative case
volume, fellowship training, residency program type, and mandatory research. First-time pass
rates on the qualifying examination and certifying examination were 78% and 74% respectively.
Multivariable analysis revealed that there was a decreased likelihood of first-time pass rates of
33
both exams if the score was below 35% on the ABSITE and less than 200 on the USMLE Step 1.
The odds ratio on the qualifying examination was 0.23 [95% CI 0.08-0.68], and the odds ratio on
the certifying examination was 0.35 [95% CI 0.20-0.61]. The odds ratio on the USMLE for the
qualifying and certifying examinations were 0.62 [0.21-0.62] and [0.42-0.93] respectively. With
an odds ratio of 3.3 [95% CI 1.6-6.8], the likelihood of passing on the first attempt was increased
if students participated in a mandatory research year. Authors concluded that scores on the
ABSITE and USMLE Step 1 could predict failure on the ABS qualifying and certifying
examinations.
Because there were not many studies that included predictors in the pediatric specialty,
McCaskill et al. (2007) examined the relationship between the USMLE, In-Training
Examination, and American Board of Pediatrics (ABP) board certifying examination scores. A
retrospective study was completed on 60 resident students who graduated from the University of
Florida College of Medicine in Jacksonville from 1999 to 2005. The first-time pass rate on the
ABP was 68%. Pearson correlation revealed that all variables were highly correlated. Univariate
logistic regression revealed that all tests were significant except the USMLE Step 2 scores.
Bivariate logistic regression revealed that the USMLE Step 1 had a greater impact than all three
in-training examination scores when predicting students’ success on passing the board
examination. In order for students to have an 80% chance of passing the ABP, the logistic
regression equation for predicting pass rates on the ABP was 202 using the USMLE, which is an
early predictor variable of success for first-time pass rates. Step 1 of the USMLE identified at-
risk students and proved to be a predictor of success on the pediatric board. Because this
examination is administered early, intervention can be incorporated early to increase the
likelihood of success on the ABP.
34
Sixty-four internal medical residents from one program outside of Virginia and 155
internal medical residents from three internal medicine programs in Virginia were evaluated to
determine whether the internal medicine in-training examination (ITE) could predict pass rates
on the American Board of Internal Medicine (ABIM) certifying examination (Rollins,
Martindale, Edmond, Manser, & Scheld, 1998). The study was also completed to develop a
predictor model. With a pass rate of 69%, 107 residents from Virginia passed and 48 residents
from Virginia failed the ABIM. With a pass rate of 66%, 42 residents from outside of Virginia
passed and 22 residents from outside of Virginia failed the ABIM. According to the logistic
regression model, ITE scores were statistically significant in predicting success or failure on the
ABIM. ITE scores properly predicted 87% of Virginia residents who passed and 60% of Virginia
residents who failed. ITE scores properly predicted 79% of non-Virginia residents who passed
and 75% of non-Virginia residents who failed. No significant difference was shown between ITE
score distributions for residents from Virginia and outside Virginia. A prediction model was
developed, and ITE scores predicted pass rates on the ABIM certification examination,
especially for residents who scored above 66.
Brill-Edwards et al., (2001) examined the relationship between the Royal College of
Physicians and Surgeons of Canada (RCPSC) internal medicine written examination and
American Internal Medicine In-Training Examination (AIMI-TE). Five universities in Canada
released their AIMI-TE data from 1988 to 1998. AIM-TE mean scores increased from
postgraduate Year 1 through Year 3. A strong relationship was noted between AIMI-TE scores
and the RCPSC internal medical written examination scores. The AIMI-TE is a predictor test for
the RCPSC.
35
Predictive studies in the discipline of nursing. Several studies in the nursing profession
have been performed to determine successful performance on the NCLEX-RN (National Council
Licensure Examination for registered nurses). Higgins (2005) sought strategies for lowering
attrition rates and raising NCLEX-RN first-time pass rates at Trinity Valley Community College.
From the fall of 1999 to the fall of 2000, ex post facto data were collected from the records of
213 former nursing students. Qualitative data were also collected from the following: 10 full-
time faculty, 30 new graduates, and 45 directors of associate degree nursing programs in Texas.
With regard to lowering attrition rates, Anatomy and Physiology II, microbiology, and
prerequisite test components of math, science, and reading were associated with successful
completion of the nursing program. First-time pass rates were correlated to Anatomy and
Physiology I, the science component of the preadmission test, the Health Education Systems,
Inc. (HESI) Exit Exam score, and the nursing skills course. Attrition and first-time pass rates
were influenced by the following qualitative data: preadmission requirements, campus
counselors, remediation, faculty, test-item writing, and teaching method, which should include
critical thinking skills, test revisions, and test reviews. These findings will assist in identifying
at-risk students so that early intervention is possible to increase the likelihood of first-time pass
rates on the NCLEX-RN.
Because former studies did not have large enough sample sizes, Romeo (2013) used a
larger sample size to examine the ability of the Educational Resources, Inc. (ERI) RN assessment
test, nursing GPA, and combined math and verbal SAT scores to predict first-time pass rates on
the NCLEX-RN. Using a retrospective, quantitative, comparative design, Romeo evaluated 182
student records for associate degree graduates between the years of 2005-2007. Critical thinking
was calculated by using six subscale scores from the ERI. Pearson correlation indicated that ERI
36
composite score and critical thinking composite score had the largest correlation. ERI was
positively correlated with nursing GPA and combined SAT score. A statistically significant
difference shown between the prioritizing and discriminating critical thinking subscale and SAT
scores. There was a large correlation between NCLEX-RN score to nursing GPA and ERI
composite scores. Goal setting or the fourth critical thinking subscale, ERI, and critical thinking
composite score were statistically significant predictors. Logistic regression revealed that nursing
GPA most powerfully predicted first-time pass rates with a mean GPA of 3.08 for students who
passed and with a mean GPA of 2.49 for those who failed on the first attempt. This study
suggests that critical thinking skills must be used to receive a satisfactory score on the NCLEX-
RN, and critical thinking ability can be assessed with the ERI. The conclusion is that critical
thinking skills are important for nursing education and licensure. Because of the importance of
critical thinking skills regarding the nursing licensure exam, strategies should be developed to
enhance critical thinking skills in nursing programs.
In a retrospective study, Spurlock and Hunt (2008) investigated whether the HESI could
predict pass rates on the NCLEX-RN and whether any disparities that exist between HESI Exit
Exam predictions and NCLEX-RN performance could be explained. Using student records, this
descriptive, correlational design study used data from January 2004 to July 2005. The
investigation showed that the HESI is not able to predict first-time pass rates on the NCLEX-RN.
Caution is advised when making decisions regarding progression of nursing students based on
the HESI Exit Exam. Caution should also be used because increased pressure for students to pass
HESI could not only interfere with their learning but could also devalue the educational
experience that they successfully completed prior to taking the HESI.
37
Predictive studies in the discipline of athletic training. Predictive studies in athletic
training have also determined that GPA is a predictor of success on the National Athletic
Trainers’ Association Board of Certification (NATABOC) Examination. One study was
completed on 270 candidates to determine whether GPA and the number of clinical hours could
predict first-time pass rates on the NATABOC (Middlemas et al., 2001). GPA, number of
clinical hours completed, sex, route to certification eligibility, scores on the education section of
the certification examination, and pass/fail criteria for each section were assessed for candidates.
These candidates took the certification examination between April and June 1998. The passing
criteria included the passing of all three sections of the examination, which included the written,
practical, and written simulation sections; the failing criteria included failing all three sections.
The two predictor variables were GPA and the number of clinical hours. Results revealed that
there was a significant difference for the scores for curriculum and internship candidates on the
written and practical sections of the examination. Significant differences were noted for both
predictor variables with GPA being significant for all portions of the examination and clinical
hours being significant for the overall examination. The fail criteria were significant also. The
inference is that GPA and the number of clinical hours are potential predictors of first-time pass
rates on the NATABOC.
In a study by Harrelson, Gallaspy, Knight, and Leaver-Dunn (1997), 52 students, 38
males and 14 females, who attended the University of Southern Mississippi between 1978 and
1992 were evaluated to determine whether multiple variables could predict success on the
NATABOC. Variables included overall GPA, athletic training GPA, academic minor, academic
minor GPA, fraternity or sorority affiliation, ACT composite, teaching versus nonteaching track,
and the number of semesters enrolled. These students took a survey, which had face validity as
38
determined by 10 certified athletic trainers who were also educators at the university. Content
validity of NATABOC examination was determined by the Role Delineation Study. Forward
linear regression revealed that there was not one variable that predicted success. However
multiple discriminant analysis revealed that a composite set including GPA, athletic training
GPA, ACT composite score, academic minor GPA, and the number of semester hours enrolled in
the university accounted for 42% of the variance. Therefore, these factors were the strongest
predictors of first-time pass rates on the NATABOC.
Predictive study in the discipline of occupational therapy. Studies in occupational
therapy have been completed to determine first-time pass rates on the National Board for
Certification in Occupational Therapy (NBCOT). In a nonexperimental correlation research
design, Truskowski (2016) collected information regarding first-time pass rate reports between
November 2013 and January 2014. One hundred forty entry-level master’s degree programs
were used to determine the relationship between predictor variables, class size and graduate
credits offered, and the NBCOT. Pearson correlation revealed that there was a weak positive
correlation between the number of graduate credits and pass rates (r = 0.157) and a significant
relationship (p = 0.032) at the 0.05 level. There was also a weak positive correlation between
average class size and pass rates (r = 0.079) and no significant relationship (p = 0.176) at the
0.05 level. There was not a significant difference noted in NBCOT pass rates between groups
based on class size or number of graduate credits offered. The regression model was mostly
explained by the number of graduate credits. Because there was not a significant relationship
between the independent variables, number of graduate credits and average class size, and the
NBCOT, other variables should be evaluated to predict first-time pass rates on the NBCOT.
39
Predictive studies in the discipline of physical therapy. Physical therapy has become
an attractive profession that many students are pursuing. According to data that was generated by
Physical Therapist Centralized Application Service (PTCAS), of the 104,579 applications for the
2014-2015 admissions cycle, there were 17,587 verified physical therapy applicants. Of the
114,027 physical therapy applications for the 2015-2016 admissions cycle, there were 18,479
verified physical therapy applicants. Of the 118,620 applications for the 2016-2017 admissions
cycle, 19,025 physical therapy applicants were verified by PTCAS (American Physical Therapy
Association, 2017). This massive number demonstrates the competitiveness of PT programs.
With the vast amounts of applicants each year, it is important to admit qualified students. Several
studies have been completed to formulate models for applicants that will predict their success in
PT and PTA programs.
Predicting success in a PT or PTA program is the initial concern for students and faculty
because successful completion of the program is the first step for eligibility to sit for the NPTE.
Utzman et al. (2007a) completed a study to determine whether preadmission demographic data,
GPA, verbal graduate record examination GRE (vGRE), and quantitative GRE (qGRE) would
predict the academic difficulty in PT programs. Twenty PT programs, which consisted of
master’s- and doctoral-level programs, were assessed. The inclusion criteria for these PT
programs were the use of the GRE and the size of the cohort. The following independent
variables were used: undergraduate GPA (uGPA), vGRE, qGRE, and size of the cohort or 30
students in the graduating PT cohort. Academic difficulty was the dependent variable. Age,
ethnicity, uGPA, vGRE, and qGRE contributed to academic difficulty. Undergraduate GPA was
the strongest predictor of academic difficulty. Even though age, ethnicity, uGPA, vGRE, and
qGRE contributed to academic difficulty, there was a lot of variability in the results. Because of
40
the increased variability in the results, these authors concluded that it is vital that academic
programs formulate their own predictor models for academic difficulty.
Three consecutive Doctor of Physical Therapy (DPT) classes were examined between
2009 and 2006 to determine whether preadmission variables could predict minority student
academic performance in a northeastern region DPT program (Shiyko & Pappas, 2009). The
sample included 100 students with 43% of the students from minority groups, 30% of the
students older than 25 years of age, and 26% of the students being male. The variables included
first-year graduate GPA (GGPA), academic status, one-hour interview with faculty, two short
written essays, and three letters of recommendation. Multiple regression analysis revealed that
the five predictors of GGPA were uGPA, qGRE, vGRE, age, and essay scores. These predictors
explained 50% of the variance in GGPA. There was only one regression analysis for academic
difficulties. Four predictors were included in this model: uGPA, qGRE, age, and interaction of
age and uGPA. GRE and uGPA were strong predictors. Having a high GPA, qGRE score, vGRE
score, interview score, and essay score increased the likelihood of success in PT programs and
GRE scores were very useful in predicting successful completion of PT programs.
Predictive studies in the discipline of physical therapist assistant. Several predictive
studies have been completed in PT to predict pass rates on the NPTE. Maring and Costello
(2009) examined the relationship among PTA education program characteristics, student
characteristics, and pass rates on the NPTE. The authors also examined predictors of first-time
and ultimate success on the NPTE based on student and program characteristics. Fifty out of 233
program directors completed surveys in 2005 for students who took the NPTE in 2004. Variables
included program setting, curricular design, graduation rates, faculty/student ratio, program
accreditation status, program length and general education, professional, clinical education
41
credits, faculty qualifications, student GPA, demographics, and applicant selection process.
There was a significant correlation between public versus private institution, program
establishment, clinical and general education credit hours as a percentage of total credits, and
first-time pass rates. A significant correlation was found among ultimate pass rates and public
versus private institution, program establishment, and clinical education credit hours as a
percentage of total credits. The best predictors for first-time pass rates were program
establishment and clinical education credit hours as a percentage of total credits (F = 7.48; p =
.002; r = .495; r2 = .245). The best predictors for ultimate pass rates were public versus private
institution and program establishment (F = 7.68; p = .001; r = .500; r2 =. 250). Based on these
results, educational program and student quality influenced first-time pass rates on the NPTE.
Therefore, updated curricula, proper allocation of time for required PTA competencies, and
qualified applicants should be considered to improve the outcomes on the NPTE.
Gresham, Thompson, Luedtke-Hoffmann, and Tietze (2015) completed a
nonexperimental correlation design to study institutional and program factors as they relate to
graduation and NPTE pass rates. Using the inclusion factor of programs graduating more than
five graduates in 2012, the institutional and program factors of 274 PTA programs were
examined to determine whether these factors could predict successful graduation outcomes. As a
part of a larger investigation, this study was conducted in August and September of 2013 for all
PTA programs. Dependent variables included first-time licensure pass rates for 2011 and 2012,
ultimate licensure pass rates for 2009 through 2011, and graduation rates for 2011. Independent
variables included institutional status, complete program length, clinical experience length,
percentage of program weeks in fulltime clinical education, financial characteristics of program,
program space characteristics, student body characteristics, and collective faculty characteristics.
42
The regression model for the 2011 graduation rate included total operational expenses per
graduate, percentage of fulltime clinical education, and complete program length. This model
accounted for 6.5% of the variance in 2011 graduation rates. The regression model for overall
pass rate included institutional status and cohorts per year. Accounting for 8.2% and 9.8% of the
variance in first-time pass rate, the regression model for first-time pass rate in 2011 and 2012
respectively was institutional status. The regression model for ultimate pass rate also included
institutional status and accounted for 14.3% of the variance in ultimate pass rate. The
interpretation of the results indicated that program outcomes can be predicted based on the
number of cohorts per year and percentage of program weeks for fulltime clinical education.
When program weeks of fulltime clinical education increase, there is a greater likelihood of
higher graduation rates. NPTE pass rates could be predicted based on institutional status. First-
time and ultimate pass rates decrease in for-profit institutions.
Seventy-two students from seven public and private New-England-based PTA programs
were evaluated from 2003 to 2005 to determine whether combined Anatomy and Physiology
courses, PTA coursework GPA, and Clinical Performance Instrument (CPI) could predict pass
rates on the NPTE (Desmarais et al., 2011). Variables included Anatomy and Physiology I and II
courses; PTA coursework GPA; CPI; and demographic information, such as age, gender, and
previous degree earned. CPI did not predict first-time pass rates on the NPTE, but PTA GPA and
Anatomy and Physiology courses did. Results showed that the greatest correlation existed
between PTA GPA and Anatomy and Physiology courses. Accounting for 23% of the variance,
PTA GPA was significant (r = .481, p < .01), and a GPA of 3.05 indicated that students were
more likely to pass the NPTE. Accounting for 8% of the variance, Anatomy and Physiology I
and II were significant (r = .301, p < .05), and an average grade of 3.56 indicated that students
43
were more likely to pass the NPTE. A moderate positive correlation (r = .441, p < .01) also
existed between Anatomy and Physiology I and II and PTA GPA. PTA GPA was the better
predictor of first-time pass rate success on the NPTE.
In a retrospective design by Maring et al. (2013), 178 PTA private and public programs
were included in a study to determine the relationship among PTA curricula, faculty and cohort
factors, and first-time and ultimate pass rates. These authors sought to determine a predictor
model based on these variables for first-time and ultimate pass rates. Using Annual Accreditation
Reports from CAPTE, the following variables were analyzed for cohort/student: ethnic
minorities, percentage of applicants accepted, and proportion of students who graduated. Faculty
variables included years of program experience for program directors and academic clinical
coordinators of education (ACCE) in their faculty roles and student/faculty ratio. Curriculum
variables included lecture contact hours, lab contact hours, clinical education hours, and
percentage technical credits. Bivariate correlation suggested that number of lab contact hours and
ACCE’s program experience were significantly and positively associated with first-time pass
rate. There was a significantly inverse correlation between graduation rate and first-time pass
rate and graduation rate and ultimate NPTE pass rate. As NPTE ultimate pass rate decreased,
PTA graduation rate increased. Logistic regression indicated that first-time pass rate predictors
were number of laboratory and clinical education hours, graduation rate, minority enrollment
percentages, and program report submittal two or more years following accreditation visit.
Bivariate correlation suggested that the number of lab contact hours were significantly and
positively associated with ultimate pass rate. Graduation rate and private versus public
institutions were inversely related to ultimate NPTE pass rate. Logistic regression indicated that
number of lab contact hours, clinical education hours, minority student enrollment percentage,
44
graduation rate, acceptance rate, probation history, and student/faculty ratio were predictors of
ultimate NPTE pass rate success. The predictor models for first-time and ultimate pass rates can
assist directors and faculty to develop PTA curricula that will increase the likelihood of success
on the NPTE.
In a retrospective design experiment, Kabiri, Voight, Gleeson, and Mitchell (2017)
examined data that were returned from accredited PTA programs to determine whether
admission criteria could predict success in PTA programs and on the NPTE. Faculty from Texas
Woman’s University and Houston Community College sent an e-mail invitation to all PTA
programs that were accredited by CAPTE as of 2016. Thirty-one PTA programs were included
in this study, and data were collected from 31 PTA programs on 2,809 PTA students who
graduated, were dismissed, or left the PTA program from 2009 through 2013. All ethnic
categories, both genders, and public, private, and for-profit institutions were included in this
study. CAPTE-accredited institutions that did not submit data were excluded. The variables that
were considered were final grades from Anatomy and Physiology (A&P) I, College Algebra,
English Composition I, overall prerequisite GPA, ACT, and Test of Essential Academic Skills
(TEAS). Outcome variables were academic and ultimate NPTE success. For academic success,
percent explained variance were as follows for A&P I, College Algebra, English Composition I,
overall prerequisite GPA, ACT, TEAS total, and TEAS math subtest score respectively: 2%,
8.9%, 2.4%, 4.5%, .9%, 7.4%, and 5.9%. For academic success, Pearson correlation was as
follows for A&P I, College Algebra, English Composition I, overall prerequisite GPA, ACT,
TEAS total, and TEAS math subtest score respectively: .113, .230, .122, .170, .064, .198, and
.167. For NPTE success, percent explained variance was as follows for A&P I, overall
prerequisite GPA, ACT composite score, TEAS total score, and science subtest score
45
respectively: 2.4%, 3.0%, 8.0%, 6.6%, and 6.0%. For NPTE success, Pearson correlation was as
follows for A&P I, overall prerequisite GPA, ACT composite score, TEAS total score, and
science subtest score respectively: .086, .105, .183, .137, and .125. A&P I, College Algebra,
English Composition I, overall prerequisite GPA, TEAS total score, and TEAS math subtest
score were significant predictors of academic success. A&P I, overall prerequisite GPA, ACT
composite score, TEAS total score, and science subtest score were significant predictors of
NPTE success. Based on the results, A&P I grade, overall prerequisite GPA, and TEAS total
score predicted academic and NPTE success and should be variables that are considered for PTA
education programs.
Predictive Studies in PTA Programs Using the NDRT
In a study by Sloas et al. (2013), five cohorts of PTA students were evaluated to
determine whether cognitive program assessment variables could predict students at risk of
failure on the NPTE. The study consisted of 111 PTA students who graduated from Arkansas
State University between 2005 to 2009. To analyze the effectiveness of the predictive formulas,
data from the class of 2010 were used. Independent variables included the NDRT, grades from
eight core courses, GPA prior to admission, and three mock NPTE exam scores. The NPTE was
the dependent variable. The eight core courses included Patient Care Fundamentals, Movement
Science, Physical Agents and Massage (PAM), Musculoskeletal PT, Neuromuscular PT I,
Neuromuscular PT II, Cardiopulmonary PT, and Seminar. Mock NPTE exams were given after
the end of the first, second, and final semester. There were weak correlations between the
vocabulary portion of the NDRT and NPTE (r = .394) and between the comprehension portion of
the NDRT and NPTE (r = .396). The relationship between the total NDRT and NPTE was the
strongest (r = .481). Even though the total NDRT was the strongest, the vocabulary portion of
46
the NDRT was the most predictive in the regression formula. All of the students who passed the
NPTE were correctly predicted to pass the exam with a scaled score of 600. Using the first
regression equation, 1 of 6 failures was predicted with the score at 600, and all six failures plus
two who did not fail were identified when the score increased to 620. Using the second
regression equation, 3 of 6 failures were predicted with the score at 600, and all six failures plus
four who did not fail were identified when the score increased to 615. Using the third regression
equation, 5 of 6 failures were predicted with the score at 600, and all six failures plus three who
did not fail were identified when the score increased to 617. Accounting for 57.4% of the
variance in the NPTE score, the third equation was the most predictive. A predictor formula was
devised and was beneficial in identifying students who needed early intervention to increase their
likelihood of passing the NPTE on the first attempt.
To determine whether a relationship existed among reading ability, textbook readability,
and the NPTE, data were collected from 161 graduates of the PTA program at Arkansas State
University from 2005 to 2014 (Keith et al., 2014). Variables included the reading ability as
assessed by the NDRT, cumulative PTA program GPA, courses taken in the PTA program, and
the NPTE. Courses included Movement Science, PAM, Musculoskeletal PT, Neuromuscular PT
I and II, Pathophysiological Conditions, and Patient Care. Textbooks included Fundamental
Orthopedic Management, Pathology for the PTA, Neurologic Interventions for PT, Clinical
Kinesiology and Anatomy, and Health Services. Results showed that there was a significant
relationship between total reading score and the NDRT and course scores. A moderate
correlation (r = .428, p < .01) existed between total reading score and the NPTE, and a low
correlation (r = .245, -.401, p < .01) existed between total reading score and course scores. Of the
5.5% of students who had a NDRT grade equivalent below the 12th-grade level, 4 of the 9 were
47
successful on the NPTE on the first attempt. Of the 81 students who had a NDRT grade
equivalent above the 14th-grade level, six students were not successful on the NPTE on the first
attempt. The mean for the total reading score was 14.6714. Using the Gunning Fog formula,
textbooks ranged from grade equivalent 11.10 to 16.30. Three out of five of the textbooks that
were used were above the mean reading level for the 161 students. Mean class average for the
course that corresponded to the textbook was correlated with grade equivalent for each of the
textbooks. Using the Gunning Fog formula, the relationship for textbook readability showed that
as the reading level of textbooks increased, the mean class average decreased. This study
demonstrated that even though reading ability can influence learning and success, reading ability
does not always determine successful outcomes for every student. Because there were students
with low NDRT scores who passed the NPTE on the first attempt and students with high NDRT
scores who failed the NPTE on the first attempt, the NDRT should be used in combination with
other predictor variables.
Predictive Studies in PT Programs Using Cognitive and Noncognitive Variables

Predictor variables that are based on faculty characteristics, institutional characteristics,
and student characteristics have also been studied in PT. Whereas the study performed on
medical resident students by De Virgilio et al. (2010) suggested that first-time pass rates
increased when students participated in a mandatory research, Cook, Landry, Covington,
McCallum, and Engelhard (2015) investigated whether student success on the NPTE could be
predicted by research completed by faculty. One hundred eighty-five PT programs were used in
this observational study. Variables that were used for research included peer-reviewed
publications and books, number of professional presentations, number of scholarly submissions,
total grant dollars, and number of grants submitted. Results showed that there were significant
48
differences for number of school artifacts submitted, faculty with grants, and grant proposals
submitted; 100% 3-year pass rates increased when the number for these variables were high. One
of the main conclusions was that institutions and their environments influence student learning.
Using a survey that they developed, Mohr, Ingram, Hayes, and Du (2005) completed a
retrospective design and surveyed program directors from 132 CAPTE-accredited programs to
examine the effect of educational program characteristics on NPTE pass rates. The survey
included many variables, such as program funding type, curriculum design, cohort size,
accreditation status, number of fulltime faculty, number of faculty with PhD or EdD, years of
preprofessional and professional coursework combined, and number of didactic and clinical
experience weeks. Significant relationships were noted with accreditation status, the number of
faculty with a PhD and an EdD, and years of preprofessional and professional coursework
combined and NPTE scores. Inference could be made that improving educational preparation by
allowing programs to evaluate their program characteristics, recruit qualified applicants, and
employ competent faculty could increase the predictability of first-time pass rates on the NPTE.
Because there were few studies that used large samples to examine student level and
institutional level as possible predictors of success rates on the NPTE, Riddle, Utzman, Jewell,
Pearson, and Kong (2009) decided to pursue this endeavor. In 2000 to 2004, 20 PT education
programs were examined to determine whether student level and program level, public versus
private institutional status, and Carnegie Classification could predict failure on the NPTE. Quota
and random sampling were used in selecting 3,066 students from PT programs in the United
States. Performance on the NPTE, demographic characteristics, preadmission data, academic
performance data, and program-level variables were collected and analyzed. Academic difficulty
did predict NPTE failure with an odds ratio of 5.89. Even though the odds varied with
49
institutional status and Carnegie class, these variables were related to NPTE pass rates. Because
academic difficulty predicted NPTE failure (p < .09), it is recommended that students who are
having difficulty in PT school seek early intervention and that faculty develop strategies to
increase the likelihood of first-time pass rates.
In a retrospective study by Utley, Brown, and Robel (2016), four cohorts of 194 third-
year PT students were examined to determine whether full-time clinical education experience
(CEE) had an impact on cognitive knowledge using a program specific written comprehension
examination. This study was conducted from 2010 to 2013 in a Midwest entry-level doctoral
program. No significant difference was shown between CEE and comprehension examination (F
= .823, p = .606). There was a small, moderate positive correlation between academic course
grades and comprehension examination content scores. A large positive correlation was noted
between all academic course grades and cumulative comprehension examination scores. Based
on the results of this study, it can be implied that CEE might not affect performance on the
NPTE.
A total of 42 graduates were contacted by mail to participate in an investigation to
determine whether there was a relationship among academic performance, clinical performance,
critical thinking skills, and the NPTE (Vendrely, 2007). The California Critical Thinking Skills
Test (CCTST) was used to assess critical thinking ability. Clinical performance was assessed
using the CPI, and academic performance was assessed using final GPA. A significant
relationship (r = .307, p = .098) was noted on Form A of the CCTST. Academic performance
was significant (r = .338, p = .032). CPI was not correlated to any of the variables. There was a
relationship between CCTST, GPA, and NPTE.
50
The cognitive variables__ GPA, ACT, and SAT__ have been mentioned in several studies
and have been documented as predictors of passing the NPTE. One study that was conducted by
Roehrig (1988) indicated that ACT and GPA could predict scores on the NPTE. More recently,
Galleher, Rundquist, Barker, and Chang (2012) investigated 49 students from seven doctoral PT
programs to determine whether cognitive and noncognitive factors could predict first-time pass
rates on the NPTE. The only significant variable predicting first-time pass rates on the NPTE
was SAT (p = .012, p < .05).
From 2000 to 2004, Utzman, Riddle, and Jewell (2007b) used demographic and
quantitative admission data to determine whether preadmission demographic data, undergraduate
GPA (uGPA), vGRE, and qGRE scores would predict failure on the NPTE. Twenty PT programs
and 3,365 students nationwide in master’s- and doctoral-level programs were used in this study.
The prediction model included uGPA, vGRE, and qGRE. With a 95% CI [0.660-0.715], the
vGRE score was the most consistent predictor of failure on the NPTE. Prediction rules for
individual programs varied; therefore, programs should design their own predictor models for
NPTE failure with the inclusion of GPA and GRE to identify at-risk students.
Fell, Mabey, Mohr, and Ingram (2015) sought to determine whether the type of
bachelor’s degree could predict pass rates on the NPTE. In a retrospective observational design,
290 graduates from the University of Tennessee-Chattanooga and University of North Dakota PT
programs were studied. The following variables were used: admission undergraduate degree
status, admission SGPA, cumulative GPA (CGPA), professional program GPA (PGPA), first
attempt on the NPTE, and total attempts to pass the NPTE. With 33% of the variance in PGPA
accounted for by CGPA and degree status, admission CGPA and degree status predicted PGPA.
The predictor model for first-time NPTE success rate included admission SGPA, PGPA, and
51
degree status. PGPA accounted for the greatest amount of variability; PGPA accounted for 32%
of the variance for NPTE pass rate. Admission SGPA accounted for 8% of the variability, and
degree status accounted for 1% of the variability. Predictor scores were formulated using this
analysis. A score of 651 on the NPTE would be expected to be obtained by students with no
degree, a 3.69 PGPA, and a 3.42 SGPA. A score of 661 on the NPTE would be expected to be
obtained by students with a degree, a 3.69 PGPA, and a 3.42 SGPA. Programs can use these
results to consider students who only have 3 years of prerequisites.
Using 14 modifiable variables, Cook et al. (2015) used information that was provided in
2011 to examine if there was a relationship among modifiable variables, first-time pass rates, and
3-year ultimate pass rates. By reviewing information from 185 CAPTE-accredited programs in
the United States and Puerto Rico, they also attempted to formulate a predictor model for first-
time pass rate and 3-year ultimate pass rate. There was a significant relationship between first-
time pass rate and average age of the cohort with an odds ratio of 0.58 [95% CI = 0.39-0.85].
There was also a relationship between mean uGPA and first-time pass rate and three-year
ultimate pass rate with odds ratios of 2.87 [95% CI = 1.08-7.59] and 5.46 [95% CI = 2.27-13.12]
respectively. The only modifiable predictor variable for first-time pass rate and three-year
ultimate pass rate was mean uGPA. These results indicated that programs should consider
student variables, such as uGPA, and be more selective in the admission process.
A retrospective study was completed on eight Texas PT programs for the classes of 2004
to 2007 to determine if there was a relationship between performance on the Physical Therapist
Manual for the Assessment of Clinical Skills (PT MACS) and the NPTE and between academic
and NPTE performance (Luedtke-Hoffmann, Dillon, Utsey, & Tomaka, 2012). This study was
completed on 967 graduates from Hardin Simmons University, Texas State University, Texas
52
Tech University, Texas Woman’s University, University of Texas El Paso, University of Texas
Health Sciences Center San Antonio, University of Texas Medical Branch, and University of
Texas Southwestern School of Allied Health Sciences. Clinical education consisted of eight
semesters or equivalence in quarters and 24-32 weeks with a mean of 30 weeks. There was a
small significant correlation between Evaluation and Diagnosis and the corresponding portion of
the NPTE and Outcomes and the corresponding portion of the NPTE. There was also a small
correlation with visual analog scale ratings and NPTE score. GPA had the largest correlation (r =
.512, p < .001) with the NPTE. Results demonstrated that GPA should be considered a strong
predictor of NPTE success.
Ninety-two alumni, who graduated between 2001 and 2003 from the University of
Scranton, were evaluated to determine whether age at graduation, PGPA, comprehensive
examination score, and CPI score were related to the NPTE (Kosmahl, 2005). Data analysis
revealed that PGPA and comprehension examination score were the best predictors and
correlated the most with the NPTE score; these predictor variables explained 47% of the
variability in the score. Academic performance in PT programs is related to NPTE success.
Several studies have indicated that GPA is a strong predictor of successful performance
on the NPTE. However, Guffey’s (2000) dissertation revealed that GPA alone should not be
considered a strong predictor of success on the NPTE for those seeking a bachelor’s-level degree
in PT. Guffey focused on predicting pass rates on the NPTE using cognitive and noncognitive
variables. In a retrospective correlational research design, a convenience sample of 57 students
from three cohorts graduating in 1998 to 2000 from Arkansas State University were studied.
Cognitive variables included GPA, SGPA, and overall Admissions Scale scores. The
noncognitive variable included the Non-Cognitive Questionnaire-Revised (NCQ-R), which was
53
previously reported as reliable and valid constructively and predictively. Accounting for 5.2% of
the variance in NPTE scores, GPA was not a strong predictor. Accounting for 0.2% of the
variance in NPTE scores, SGPA was not a strong predictor. Accounting for 1.4% of the variance
in NPTE scores, admission scores were weak predictors. Cognitive variables cumulatively
accounted for 6.6% of the variance in NPTE scores. With the long-range goal subset of the
NCQ-R being the only significant predictor (8.3%), the total score for the NCQ-R only
accounted for 3.2% of the variance in NPTE scores. The combination of cognitive and
noncognitive variables accounted for 4.0% of the variance in NPTE scores. Results indicated that
noncognitive variables should be considered when attempting to identify students who will be
successful in obtaining higher scores on the NPTE.
Predictive Studies in PT Programs Using the NDRT and HSRT
Not only has GPA been used to predict success rates on board examinations, but
predictor models have also been formulated using the NDRT and HSRT as predictor variables.
To investigate the relationship between reading comprehension and the NPTE, Aldridge et al.
(2010) completed a retrospective correlation research design on 67 students who graduated from
the PT program at Arkansas State University between 2002 and 2007. The correlation between
the scaled score on reading comprehension, as measured by the NDRT, and the scaled score on
the NPTE for the first attempt was explored on five cohorts of master’s-level students. With the
NDRT accounting for 27% of the variance on the NPTE, there was a significant correlation (r =
0.519, p = 0.01) and a moderately positive relationship between NDRT and NPTE. The results
suggest that there is a link between reading ability and comprehension and scoring ability on the
NPTE. With the NDRT accounting for 25% of the variance on the NPTE, there was also a
significant correlation (r = 0.506, p = 0.01) and a moderately positive relationship between
54
NDRT and NPTE first-time pass rates. The results suggest that there is a link between reading
ability and reading comprehension and successful scoring ability on the NPTE. Accounting for
15% of the variance in scaled scores on the NPTE, scaled scores on the NDRT were weakly
related to the NPTE for students who were not successful on the first attempt. concluded that the
NDRT is a variable that has the potential to predict first-time pass rates on the NPTE.
In a retrospective design experiment, Huhn and Parrott (2017) used four cohorts of PT
students to determine whether a relationship existed between the HSRT and NPTE. Using 160
students from Rutgers University, these authors also used data to determine if a relationship
existed among the HSRT, GRE, and uGPA that would augment the admissions process. All
predictor variables correlated significantly with the NPTE. Correlations were as follows for
predictor variables and the NPTE: HRST (r = .430, p < .001), uGPA (r = .235, p < .001), GRE (r
= .372, p < .001), and final GPA (r = .598, p < .001), which was the strongest correlation. There
was a significantly moderate correlation between HSRT and GRE (r = .398, p < .001) and final
GPA (r = .328, p < .001). A model was formulated for predicting success on the NPTE. The
formula was as follows: “376.62 + 0.08(GRE) + 27.93 (uGPA) + 4.25 (HSRT)” (Huhn &
Parrott, 2015, p. 10). Based on the results, HSRT may not only predict success in PT programs,
especially when uGPA and GRE are low, but may also predict success on the NPTE.
Conclusion
Numerous predictor models for successfully completing programs and board
examinations have been formulated in many fields of study. Whereas variables, such as the
number of graduate credits, average class size, and the HESI as a single predictor, have been
shown not to be predictors for program and board examination success, many studies have
revealed that board examination success can be predicted by several factors. These factors
55
include GPA; reading ability; critical thinking skills; in-training, summative, and preadmission
examinations; class rankings; membership status; specific coursework; and extended time.
Studies that focused on PTA and PT education revealed that both cognitive and noncognitive
aspects predicted success in programs and on the NPTE. Some of these predictor variables
included the following: GPA, reading ability, critical thinking skills, GRE, academic difficulty,
age of cohort, institutional characteristics, program characteristics, faculty characteristics, mock
examinations, specific courses, lab and clinical hours, and graduation rate.
As a single predictor and in combination with other variables, GPA has been
demonstrated to be one main predictor of success in programs and on board examinations. GPA
has been indicated to be a predictor of success on the NPTE; this shows that grades actually do
matter, and good grades can equate to success in PT programs, PTA programs, and on the NPTE.
Reading ability has been linked to success in various disciples. In the healthcare
profession, many programs have lengthy reading assignments; therefore, students having a
reading ability that is as equivalent as possible to the reading levels of textbooks is paramount.
Higher reading ability has been associated with increased likelihood of success in programs, such
as PT and PTA programs, and on board examinations, such as the NPTE. Because reading ability
has been demonstrated to be a predictor variable for the NPTE, inclusion of the NDRT should be
incorporated as an evaluative method prior to students’ matriculation through PT and PTA
programs.
Critical thinking and clinical reasoning have been proven to be effective in the clinical
setting with making accurate diagnoses. Critical thinking skills have also been an asset in
predicting success in health care professional programs and on board examinations. There are no
56
exceptions with critical thinking and clinical reasoning predictability in PT and PTA programs.
Critical thinking and clinical reasoning have been positive indicators of success on the NPTE.
In conclusion, GPA, reading ability, and critical thinking skills have been predictors of
DPT and PTA program and NPTE success. Because there are currently no studies using the
combination of GPA, the NDRT, and HSRT, these variables were used in this study. Program
GPA, the NDRT, and the HSRT were used to determine their relationships with each other and
the NPTE. The NDRT and uGPA and the NDRT and prerequisite GPA were used to determine
whether they predicted program success. Moreover, these predictor variables were used to
determine if they predicted first-time pass rates on the NPTE.
57
CHAPTER 3
METHODOLOGY
Purpose of the Study
Historically, the Nelson Denny Reading Test (NDRT) and the Health Sciences Reading
Test (HSRT) have been used in combination with other predictor variables, such as grade point
average (GPA), graduate record examination (GRE), American College Testing (ACT),
Scholastic Aptitude Test (SAT), and the Medical College Admissions Test (MCAT). Because
reading comprehension and critical thinking skills are vital in successfully matriculating through
Doctor of Physical Therapy (DPT) and physical therapist assistant (PTA) programs and passing
the National Physical Therapy Examination (NPTE), it is worthwhile to investigate the
relationship between these variables and to determine whether these variables are predictors of
success in therapy programs and on the NPTE. The purpose of this study was twofold. Not only
did this study attempt to determine whether a reading test and GPA would predict success in a
DPT and PTA program, but it also attempted to determine whether a reading test, a critical
thinking skills test, and program GPA would predict first-time pass rates on the NPTE.
Design of Study
This retrospective, quantitative research design study used a convenience sample of DPT
and PTA students at Arkansas State University. This study examined the following variables to
determine if they were predictor variables for successfully matriculating through a DPT program
58
and PTA program: NDRT and undergraduate GPA (uGPA) for the DPT program and NDRT and
prerequisite GPA for the PTA program. Also, this study examined the following variables to
determine if they were predictor variables for passing the NPTE on the first attempt: NDRT,
HSRT, and program GPA for both DPT and PTA students. Because these variables can impact
students and society, it was relevant to determine whether these variables could predict success
rates in therapy programs and first-time pass rates on the NPTE. If the above-mentioned
variables proved to be a predictor model for success rates in therapy programs and first-time pass
rates on the NPTE, students, the educational program, and the physical therapy profession could
benefit with the implementation of early intervention for students who are at risk for failure.
Research Questions
The following research questions were addressed in this study:
DPT program?
program?
3. To what extent will the NDRT, HSRT, and program GPA, predict the overall scores
Population Sample
The population used in this study was from a public institution in the Southern region of
the United States. The convenience sample for this study was chosen from the DPT and PTA
programs at Arkansas State University. Because one student withdrew from the DPT program,
59
only 29 DPT students in the 2017 cohort participated in the study with regards to Research
Question 1. Because two students did not successfully complete the program, two students did
not submit their NPTE scores, and one student did not take the HSRT, only 24 DPT students in
the 2017 cohort participated in the study with regard to Research Question 3. Twenty-nine DPT
students in the 2018 cohort participated in the study with regard to Research Question 1 because
one student withdrew from the program. Because three students did not successfully complete
the program and five students did not submit their NPTE scores, only 21 DPT students in the
2018 cohort participated in this study with regard to Research Question 3. Twenty-nine PTA
students in the 2017 cohort participated in the study with regard to Research Question 2. Because
two students did not complete the HSRT, 27 PTA students in the 2017 cohort participated in the
study with regard to Research Question 4. Twenty-eight PTA students in the 2018 cohort
participated in this study with regard to Research Question 2 because one student withdrew from
the program, and 28 PTA students in the 2018 cohort participated in this study with regard to
Research Question 4. The ages of students in the DPT program ranged from 22-30. The ages of
students in the PTA program ranged from 18-56. Students had diverse racial, ethnic, cultural,
regional, and educational backgrounds.
Variables and Instruments for Measurement
The dependent variables for this study were success in DPT and PTA programs and the
scores on the NPTE. Success in the DPT and PTA programs at Arkansas State University was
operationally defined according to the standards outlined by the DPT and PTA programs at
Arkansas State University. Students who had a GPA of 3.0 and above on all coursework and
clinical rotation assignments were deemed successful in the DPT program. Students who had a
60
score of 75% and above on all coursework and clinical rotation assignments were deemed
successful in the PTA program. Success on the NPTE was operationally defined as follows.
With approval from their accredited programs, candidates are allowed to sit for the
NPTE. The NPTE is a computer-based examination that is administered by the Federation of
State Boards of Physical Therapy (FSBPT). The examination consists of four sections with 50
questions each for PTA candidates. Only 150 questions of the 200 are scored, and the other 50
questions are pretested for future board examination questions. For DPT candidates, there are
five sections with 50 questions each. Only 200 of the 250 questions are scored, and the other 50
questions are pretested for future board examination questions. Candidates are given one 15-
minute scheduled break; however, candidates are allowed to take up to three unscheduled breaks
between sections using the time allotted for the examination. The score ranges from 200-800
with a passing ranked score of 600 for both PTA and DPT candidates. “The passing score
established for the National Physical Therapy Licensure Examinations (NPTE) reflect the level
of performance requirements to provide minimally safe and competent physical therapy services
by physical therapists and physical therapist assistants” (Federation of State Boards of Physical
Therapy, 2017, para. 1).
Independent variables included, uGPA, prerequisite GPA, program GPA, NDRT, and
HSRT. Undergraduate GPA consisted of all of the coursework that was completed for the
baccalaureate degree. Prerequisite GPA was operationally defined as the academic course
requirements that were taken in order to apply to the PTA program at Arkansas State University.
With their informed consent, GPAs were retrieved from the students’ records.
Grade point average has been used as a predictor variable in DPT and PTA programs.
Vendrely (2007) determined that there was a relationship among academic performance using
61
GPA, critical thinking skills using the California Critical Thinking Skills Test, and the NPTE for
PT students. Kabiri et al. (2017) examined data that were returned from accredited PTA
programs to determine whether admission criteria could predict success in PTA programs and on
the NPTE. Based on the results, Anatomy and Physiology I grade, overall prerequisite GPA, and
Test of Essential Academic Skills total score predicted academic and NPTE success and should
be variables that are considered for PTA education programs.
The NDRT is a standardized reading test that measures the reading ability of high school
and college students and consists of vocabulary and comprehension sections. The vocabulary
portion has 80 multiple-choice questions with five possible answer choices. Fifteen minutes are
allowed for the completion of this portion of the exam. The comprehension portion consists of
five to eight passages from which students must answer three multiple-choice questions based on
content of those passages. Students are given 20 minutes to complete this portion of the exam.
Reliability of the NDRT was cited by Jackson and Brooks in 1985. These authors cited
split-halves reliability coefficients from J. I. Brown et al.’s (1993) manual as follows: 0.91 for
vocabulary, 0.74 for comprehension, and 0.90 for the total score. Reading rate alternate-form’s
reliability was 0.66.
The validity of the NDRT has been questioned. Stevens (1980) examined the NDRT to
determine whether prior knowledge of a topic would affect reading comprehension. Concurring
with other authors, Stevens determined that reading can be improved by having a prior
knowledge of the subject.
On the other hand, Jackson and Brooks (1985) conducted a study on 292 students
entering the University of Alabama School of Medicine in 1978 and 1979. They used four
criteria variables: basic science GPA, clinical science GPA, and total scores on Part 1 and Part 2
62
of the national Board of Medical Examiners. They found that the NDRT total score was a better
predictor for criteria variables and for incremental validity than the MCAT reading score.
Coleman et al. (2010) examined content validity of the NDRT. Two hundred fifty-three
college students who were not at risk for learning disabilities and 26 college students who were
at risk for learning disabilities were examined to determine the content validity of the
comprehension portion of the NDRT using Forms G and H. These students were asked to answer
questions on the comprehension section without reading the passage. Students had higher scores
on hard science passages (46.7%-56.6%) and lower scores on humanities passages (30.7-37.4). A
statistically significant difference in overall accuracy was shown between the Form H typical
group (46.6%) and the at-risk group (40.6%). These results prompt questions about whether the
comprehension section of the NDRT is measuring reading disabilities because at-risk students
scored nearly as well as typical students.
Norms have been developed on the NDRT for healthcare professionals. In order to
compare the raw scores of the NDRT for high school and 4-year college students to the raw
scores of healthcare professional students, Haught and Walls (2002) examined and converted
raw scores on Forms G or H of the NDRT for healthcare professional students. Using normative
data, the raw scores were converted into percentile rank, standard, grade equivalent, and stanine
scores for 1,122 first-year medical, dental, PT students, and internal medicine interns at West
Virginia University. Normative data are located in the NDRT manual for Scoring and
Interpretation.
The HSRT is a critical thinking test written specifically for health care. Questions are set
within a health care context. The test is a 33 multiple-choice question test that is administered in
a maximum time of 50 minutes. The test contains five subscale critical thinking areas: analysis
63
and interpretation, inference, evaluation and explanation, deductive reasoning, and inductive
reasoning.
The reliability and the validity of the HSRT have been supported in research by Insight
Assessment (2017). A reliability of .68 to .80 and a validity of .81 have been reported (Insight
Assessment, 2017). The HSRT has also been identified as a valid test that can be used to assess
critical thinking ability in PT. Using 73 PTs with clinical specialty certifications and 79 first-year
PT students from two PT programs, Huhn et al. (2011) evaluated the construct validity of the
HSRT. First-year students were from a private Midwestern university and a public East coast
university. The clinical specialists were certified in geriatrics, neurology, and orthopedics. As
indicated by a t test and one-way ANOVA, there were no differences between schools or
specialties. There was a significant difference noted for the deductive and analysis portions of
the HSRT; this difference successfully discriminated between students and expert PTs. Construct
validity was established because the HSRT successfully discriminated between the critical
thinking abilities of first-year students and clinical specialists. The HSRT can be beneficial for
students and educators when determining student weaknesses in critical thinking and developing
student remediation to improve critical thinking skills.
Huhn et al. (2013) also evaluated change in critical thinking skills. Using 37 students
from a public East Coast university and 26 students from a private Midwest university, these
authors evaluated change in critical thinking by allowing students to complete the HSRT upon
entry into the program, prior to final affiliations, and prior to graduation. There was a statistically
significant difference, which occurred between the first and second test, for the overall HSRT
score, the deductive subscale, and the analysis subscale. There was also a statistically significant
difference noted between the two programs with the Midwest’s mean score (24.85) being higher
64
than the East Coast’s mean score (22.42). These results indicated that the greatest amount of
change in critical thinking occurred during the teaching or classroom portion of the program and
not the clinical portion. Not only does the HSRT appear to be valid and measure change in
critical thinking scores, but it also appears to be a beneficial assessment tool for PT students.
Procedures
All information was retrieved from an Institutional Review Board (IRB) approved study
at Arkansas State University. Funding to administer the HSRT was secured from the Office of
Assessment at Arkansas State University in 2017 and 2018. To determine success in the DPT
program, uGPA and the NDRT were utilized. Thirty DPT students were selected for the DPT
classes of 2017 and 2018. These students completed the NDRT prior to matriculating through the
DPT program. Of the 30 students from the class of 2017, uGPA and the NDRT were utilized for
29 students because one student withdrew from the program. Of the 30 students from the class of
2018, uGPA and the NDRT were utilized for 29 students because one student withdrew from the
program.
Of the 26 DPT students in the 2017 cohort who completed the HSRT after all coursework
and clinical experiences were completed, the results of only 24 students were used because two
students did not release their NPTE scores. The results of the 24 students from the 2017 DPT
cohort were used to determine whether a predictor model for first-time success on the NPTE
could be established. All students attempted the NPTE in July 2017. Two students from the class
of 2017 did not successfully complete the DPT program, and one student withdrew from the
program. One student from this cohort was excluded because the student did not take the HSRT.
In the DPT class of 2018, three students did not successfully complete the DPT program,
and one student withdrew from the program. Twenty-five DPT students in the 2018 cohort
65
completed the HSRT in April 2017. Due to a scheduling conflict, one student in this cohort did
not complete the HSRT in 2017. However, all 26 students who remained in the class of 2018
completed the HSRT after all coursework and clinical experiences were completed. All students
attempted the NPTE for the first-time in July 2018; however, only 21 students released their
NPTE scores.
To determine success in the PTA program, prerequisite GPA and the NDRT were
utilized. Twenty-nine PTA students were selected for the PTA classes of 2017 and 2018. These
students completed the NDRT prior to matriculating through the PTA program. Prerequisite
GPA and the NDRT were utilized for 29 students in the class of 2017 and for 28 students in the
class of 2018 because one student withdrew from the program.
Twenty-seven PTA students in the 2017 cohort completed the HSRT after the
completion of coursework and clinical experiences. All students attempted the NPTE in July or
October 2017. Two students from this cohort were excluded because they did not take the HSRT.
Twenty-eight PTA students in the 2018 cohort completed the HSRT prior to matriculating
through the program and after all coursework and clinical experiences were completed. All
students attempted the NPTE for the first-time in July 2018.
Statistical Design
All information was entered into the Statistical Package for Social Sciences (SPSS) to run
statistical analysis. This software ran descriptive and mean difference statistics on the NDRT,
HSRT, GPA, and NPTE. Research Questions 1 and 2 were analyzed using a logistic regression
to predict a model for success in a DPT program and PTA program. Research Questions 3 and 4
were analyzed by using a logistic regression to predict a model for the NPTE for DPT and PTA
students.
66
Implications of the Study
Before licensure is obtained, DPT and PTA students must graduate from a DPT or PTA
program and successfully complete the NPTE. In order for students to accomplish both tasks,
they must possess good reading and critical thinking skills and, thus, be able to make sound
clinical decisions. This study was designed to assess whether students possessed these abilities.
So that students who do not possess these abilities can benefit by engaging in early intervention
programs to improve the likelihood of success rates in DPT and PTA programs and on the
NPTE, assessment of reading and critical thinking skills should be evaluated prior to students
entering therapy programs and taking national board exams. Early intervention could potentially
save students money and time.
Limitations of the Study
The major limitation of this study was the sampling process. Subjects were selected from
a convenience sample from an accessible population at Arkansas State University. DPT and PTA
students were selected from the graduating classes of 2017 and 2018. Even though efforts were
made to adequately represent the population of DPT and PTA students nationally, caution should
be used when evaluating the findings of this study because of the sampling process.
One delimitation of this study was the selection of associate- and graduate-level students
from Arkansas State University. Prediction of first-pass rates on the NPTE for DPT and PTA
students at Arkansas State University was limited to GPA and two standardized tests, the NDRT
and the HSRT. Another delimitation of this study was the administration of the standardized
tests. The NDRT and HSRT were administered at a time of convenience. The HSRT was
administered to the DPT and PTA class of 2018 on two occasions; this administration could have
resulted in maturation and practice effects. Subject effect was also another possible delimitation.
67
Students might have performed better on the HSRT if the test had been administered prior to
their clinical rotations. Furthermore, experimenter effects could have been possible since the
researcher was a professor in the DPT program; DPT students are more familiar with test
administration from the researcher than were PTA students.
68
CHAPTER 4
FINDINGS
Using 2017 and 2018 cohorts from Arkansas State University, this study attempted to
determine whether the Nelson Denny Reading Test (NDRT) and grade point average (GPA)
could predict success in a Doctor of Physical Therapy (DPT) program and Physical Therapist
Assistant (PTA) program. The study also attempted to determine whether the NDRT, the Health
Sciences Reasoning Test (HSRT), and program grade point average (GPA) could predict first-
time pass rates on the National Physical Therapy Examination (NPTE) for these two programs.
Based on the literature review, the following research questions were addressed in this
investigation:
1. To what extent do the NDRT and undergraduate GPA (uGPA) predict success in a
DPT program?
2. To what extent do the NDRT and prerequisite GPA predict success in a PTA
program?
3. To what extent do the NDRT, HSRT, and program GPA predict the overall scores on
the NPTE for DPT students?
4. To what extent do the NDRT, HSRT, and program GPA predict the overall scores on
the NPTE for PTA students?
69
Participant Demographics
The subjects of this investigation included students who were admitted into the DPT and
PTA classes of 2017 and 2018. Table 1 compares the demographics for DPT students in the
classes of 2017 and 2018. Table 2 compares the demographics for PTA students in the classes of
2017 and 2018.
Table 1
Demographics for DPT Students in the Classes of 2017 and 2018
Demographics 2017 2018
Mean Age 22.5 22.2
Gender Females 12 18
Males 18 12
Ethnicity African American 1 3
Asian 1 2
Caucasian 25 25
Hispanic 3 0
70
Table 2
Demographics for PTA Students in the Classes of 2017 and 2018
Demographics 2017 2018
Mean Age 25.6 24.4
Gender Females 18 16
Males 11 13
Ethnicity African American 0 2
African American/Caucasian 0 1
Asian/Caucasian 1 0
Caucasian 28 25
Hispanic 0 1
Statistical Results
The 23rd version of SPSS was used to analyze the data and test the research questions in
this study. To test each research question, a linear regression using a forward method was used.
The dependent variable for Research Questions 1 and 2 was program success or program GPA.
The independent variables used in the statistical analysis for Research Question 1 were the
NDRT and uGPA for DPT students. The independent variables used in the statistical analysis for
Research Question 2 were the NDRT and prerequisite GPA for PTA students. The dependent
71
variable for Research Questions 3 and 4 was NPTE success. The independent variables used in
the statistical analysis for Research Questions 3 and 4 were the NDRT, HSRT, and program
GPA.
Research Question 1. To what extent do the NDRT and undergraduate GPA (uGPA)
predict success in a DPT program? Neither the NDRT nor uGPA were significant in this
analysis, and a regression equation could not be established. Table 3 summarizes the descriptive
statistics for the independent and dependent variables for Research Question 1. Table 4
summarizes the data output for correlations for Research Question 1.
Table 3
Descriptive Statistics for the NDRT, uGPA, and Program GPA for Doctor of Physical Therapy
Students
Variable Mean Min Max N
NDRT 16.08 10.10 18.90 58
uGPA 3.71 3.00 4.00 58
Program GPA 3.65 2.35 4.00 56
72
Table 4
Correlations for the NDRT, uGPA, and Program GPA for Doctor of Physical Therapy Students
Variable Program NDRT uGPA

GPA
Program GPA 1.000 .237 .185
NDRT .237 1.000 .120
uGPA .185 .120 1.000
Research Question 2. To what extent do the NDRT and prerequisite GPA predict
success in a PTA program? There was a statistically significant correlation (p = .007). The
regression equation established a model that included prerequisite GPA, NDRT, and program
success. Based on prerequisite GPA and NDRT, a simple linear regression was calculated to
predict program success for PTA students. A significant regression equation was determined F(1,
54) = 7.728, p < .05. The predicted equation was as follows: (PTA program success) = 0.646
(prerequisite GPA) + 0.098 (NDRT) - 0.469. The relationship was determined to have been
minimally correlated at R = .464, with an R2 value of .215, which explained that 21.5% of the
variance in the dependent variable (program GPA) was due to the independent variables
(prerequisite GPA and NDRT). Table 5 summarizes the descriptive statistics for the independent
73
and dependent variables for Research Question 2. Table 6 summarizes the data output for
correlations for Research Question 2.
Table 5
Descriptive Statistics for the NDRT, Prerequisite GPA, and Program GPA for Physical
Therapist Assistant Students
NDRT 15.91 14.00 18.90 58
Prerequisite GPA 3.67 2.96 4.00 58
Program GPA 3.47 2.30 4.00 57
74
Table 6
Correlations for the NDRT, Prerequisite GPA, and Program GPA for Physical Therapist
Assistant Students
Variable Program NDRT Prerequisite GPA

GPA
Program GPA 1.000 .262* .320*
NDRT .262 1.000 -.207
Prerequisite GPA .320 -.207 1.000
* Indicates a significant correlation at the .05 level.
Research Question 3. To what extent do the NDRT, HSRT, and program GPA, predict
the overall scores on the NPTE for DPT students? There was a statistically significant correlation
(p =.0001). The regression equation determined a model including GPA and the NPTE. Based on
program GPA, a simple linear regression was calculated to predict NPTE success for DPT
students. A significant regression equation was determined F(1, 43) = 16.071, p < .05. The
predicted equation was as follows: (NPTE) = 159.428 (program GPA) + 83.770. The relationship
was determined to have been moderately correlated at R = .522, with an R2 value of .272, which
explained that 27.2% of the variance in the dependent variable (NPTE) was due to the
independent variable (program GPA). Table 7 summarizes the descriptive statistics for the
75
independent and dependent variables for Research Question 3. Table 8 summarizes the data
output for correlations for Research Question 3.
Table 7
Descriptive Statistics for the NDRT, HSRT, Program GPA, and NPTE for Doctor of Physical
Therapy Students
NDRT 15.83 10.10 18.90 45
HSRT 24.53 13.00 31.00 45
Program GPA 3.70 3.32 4.00 45
NPTE 674.20 568.00 785.00 45
76
Table 8
Correlations for the NDRT, HSRT, Program GPA, and NPTE for Doctor of Physical Therapy
Students
Variable Program NDRT HSRT NPTE

GPA
Program GPA 1.000 .194 .274 .522
NDRT .194 1.000 .551 .227
HSRT .274 .551 1.000 .382
NPTE .522* .227 .382 1.000
Research Question 4. To what extent do the NDRT, HSRT, and program GPA predict
the overall scores on the NPTE for PTA students? There was a statistically significant correlation
(p = .005). The regression equation determined a model that included program GPA and the
NPTE. Based on program GPA, a simple linear regression was calculated to NPTE success for
PTA students. A significant regression equation was determined F(1, 51) = 8.630, p < .05. The
predicted equation was as follows: (NPTE) = 55.304 (program GPA) + 3.393 (HSRT) + 397.430.
The relationship was determined to have been moderately correlated at R = .671, with an R2
value of .450, which explained that 45.0% of the variance in the dependent variable (NPTE) was
77
due to the independent variables (program GPA and HSRT). Table 9 summarizes the descriptive
statistics for the independent and dependent variables for Research Question 4. Table 10
summarizes the data output for correlations for Research Question 4.
Table 9
Descriptive Statistics for the NDRT, HSRT, Program GPA, and NPTE for Physical Therapist
Assistant Students
NDRT 15.99 14.00 18.90 54
HSRT 21.35 9.00 29.00 54
Program GPA 3.46 3.00 4.00 54
NPTE 661.30 575.00 759.00 54
78
Table 10
Correlations for the NDRT, HSRT, Program GPA, and NPTE for Physical Therapist Assistant
Students
Variable Program NDRT HSRT NPTE

GPA
Program GPA 1.000 .282 .339 .598
NDRT .282 1.000 .225 .329
HSRT .339 .225 1.000 .489
NPTE .598* .329 .489* 1.000
79
CHAPTER 5
CONCLUSIONS AND DISCUSSION
Chapter 5 will provide a general overview and discussion of the findings from the
research and statistical analysis of this study, limitations of the study, implications, and
recommendations for the study. Because so little data exist regarding the prediction of Doctor of
Physical Therapy (DPT) and Physical Therapist Assistant (PTA) program success using the
Nelson Denny Reading Test (NDRT) and no data regarding the prediction of National Physical
Therapy Examination (NPTE) success using the NDRT and Health Sciences Reasoning Test
(HSRT), this two-fold investigation was designed to address the lack of information in the
literature. Not only did this study attempt to determine whether the NDRT and GPA would
predict success in a DPT and PTA program, but it also attempted to determine whether the
NDRT, HSRT, and program GPA would predict first-time pass rates on the NPTE. To address
the following research questions, data were collected on DPT and PTA students from Arkansas
State University in 2017 and 2018:
DPT program?
program?

80
Conclusions
To test each research question, a linear regression was used to determine whether success
in a DPT program and PTA program could be determined. A linear regression was also used to
determine whether first-time success on the NPTE for DPT and PTA students could be
determined.
Research Question 1. To what extent will the NDRT and uGPA predict success in a
DPT program? There was little to no correlation found between the NDRT and program GPA in
the DPT program at Arkansas State University. Also, little to no correlation was found between
uGPA and program GPA in the DPT program at Arkansas State University. A predictor model
could not be established using the NDRT and uGPA to predict success in the DPT program at
Arkansas State University.
Research Question 2. To what extent will the NDRT and prerequisite GPA predict
success in a PTA program? There was a low correlation found between the NDRT and program
GPA in the PTA program at Arkansas State University. There was also little correlation found
between prerequisite GPA and program GPA in the PTA program at Arkansas State University.
However, both predictor variables were significant. Prerequisite GPA and the NDRT contributed
to 21.5% of the variance in program GPA. The predictor equation that was established for PTA
success was as follows: (Program success) = 0.646 (Prerequisite GPA) + 0.098 (NDRT) – 0.469.
Research Question 3. To what extent will the NDRT, HSRT, and program GPA predict
the overall scores on the NPTE for DPT students? There was little correlation found between the
NDRT and the NPTE and between the HSRT and the NPTE. A moderate correlation was found
81
between program GPA and the NPTE. The only significant variable was program GPA, which
accounted for 27.2% of the variance. The predictor equation that was established for NPTE
success for students in the DPT program is as follows: (NPTE) = 159.428 (Program GPA) +
83.770.
Research Question 4. To what extent will the NDRT, HSRT, and program GPA predict
the overall scores on the NPTE for PTA students? There was little correlation found between the
NDRT and the NPTE. A moderate correlation was found between the HSRT and the NPTE and
between program GPA and the NPTE. The HSRT and program GPA were significant variables.
Forty-five percent of the variance on the NPTE could be accounted for with program GPA and
the HSRT. The predictor equation that was established for the NPTE for PTA students was as
follows: (NPTE) = 55.304 (Program GPA) + 3.393 (HSRT) + 397.430.
Limitations of the Study
The design of the current study was subject to impact, study design, and statistical
limitations. The first impact limitation was sample bias. DPT and PTA students from the
graduating classes of 2017 and 2018 were selected from a convenience sample from an
accessible population at Arkansas State University. Selection bias was another impact limitation
because there was no subject randomization included in this study. Finally, this study was
restricted to using two cohorts of DPT and PTA students because of time constraints. Because of
time constraints, a small sample size was used. Using a small sample size resulted in constraints
on generalizability of this study, and, therefore, the results of this study are not generalizable to
other programs. Although efforts were made to adequately represent the population of DPT and
PTA students nationally, caution should be used when evaluating the findings of this study
because of the sampling population.
82
The study design was another major limitation in the study. The uGPA of DPT students
posed a limitation for this study. Many of the DPT students attended universities other than
Arkansas State University. Many of the DPT students had different majors or took additional
courses beyond the prerequisite courses required for the DPT program. Because of these factors,
the level of difficulty in coursework was different and could have impacted final undergraduate
GPA. Because of the attendance of different universities, the differences in majors, and the
differences in coursework, it was difficult to standardize uGPA for DPT students.
Because of the study’s small sample size, only the composite score of the NDRT and
HSRT were used. Using only the composite score of the NDRT and HSRT was a study design
limitation. Investigating the vocabulary and comprehension portions of the NDRT and the
subscales of the HSRT might yield more statistically significant results.
Another study design limitation was the administration of the HSRT to the 2018 cohorts.
For the DPT and PTA class of 2018, the HSRT was administered in 2017 and 2018 because the
researcher was unsure if funding would be granted for the cohorts to be tested in 2018. As a
result of testing on two occasions, administration could have resulted in maturation and practice
effects. Because of maturation or changes that occur as a function of time passing, DPT students
could have improved their ability to think critically from their second to third year in the DPT
program, and PTA students could have improved their ability to think critically during their
matriculation in the PTA program. Practice effect could have resulted from the students in the
class of 2018 being exposed to the HSRT on two occasions; students could have remembered
some of the questions on the test.
The statistical limitation was access to NPTE results. Students reported their NPTE
results to both programs. The reporting of NPTE results was low for DPT students.
83
One delimitation of this study was the selection of associate- and graduate- level students
from Arkansas State University. Prediction of first-pass rates on the NPTE for DPT and PTA
students at Arkansas State University was limited to GPA and two standardized tests, the NDRT
and the HSRT. Another delimitation of this study was the administration of the standardized
tests. The NDRT and HSRT were administered at a time of convenience. The NDRT was
administered to DPT students prior to their matriculation through the DPT program and to PTA
students as a part of the admissions process. The HSRT was administered the week of
graduation. Unfortunately, all students did not take the HSRT because of various reasons.
Subject effect was also another possible delimitation. The attitude of students could have
influenced the results of the HSRT because the test was administered the week of graduation. It
is possible that some students were mentally and physically exhausted from preparing for
graduation. It is also possible that some students were lackadaisical because there was no
incentive involved for taking the HSRT.
Since the researcher was a professor in the DPT program, experimenter effects might
have been possible for PTA students taking the HSRT. Examinations for DPT students were
usually administered by DPT faculty, and examinations for PTA students were usually
administered by PTA faculty. Hence, DPT students were more familiar with test administration
from the researcher than are PTA students. Experimenter effects could have positively affected
the attitudes of PTA students in that they might have performed better because a professor from
another program was administering the HSRT. On the other hand, experimenter effects could
have negatively impacted the attitudes of PTA students causing their performance to be worse
than it would have if a faculty member from the PTA program had administered the HSRT.
84
Discussion
Utzman et al. (2007a) concluded that academic programs should formulate their own
predictor models for academic difficulty and NPTE failure. Taking the suggestion of these
authors, academic success and NPTE success were examined at Arkansas State University. The
NDRT and uGPA were investigated on two cohorts of DPT students to determine whether these
variables could predict success in the DPT program at Arkansas State University. Neither the
NDRT nor uGPA was significant, and neither predicted success in the DPT program. Because a
predictor model could not be established for the DPT program at Arkansas State University using
the NDRT and uGPA variables, other cognitive variables, such as the Graduate Record
Examination (GRE), should be considered to predict success in the DPT program. For example,
Shiyko and Pappas (2009) concluded that having a high GPA, quantitative GRE score, verbal
GRE score, interview score, and essay score were associated with an increased likelihood of
success in PT programs. They also concluded that GRE scores were very useful in predicting
successful completion of PT programs.
After Sloas et al. (2013) completed research evaluating the value of the NDRT, the
NDRT became a part of the admissions process for the PTA program at Arkansas State
University. Based on the literature, research has not been formally extended to determine
whether the implementation of the NDRT continues to predict success in the PTA program at
Arkansas State University and on the NPTE. This study sought to determine whether a
relationship existed between the NDRT and program success and the NDRT and NPTE. Because
a predictor model could be established for program success using the NDRT and prerequisite
GPA, the PTA program should continue using these predictor variables for admissions. Results
from this study regarding prerequisite GPA confirmed research conducted by Kabiri et al.
85
(2017), who concluded that A&P I grade, overall prerequisite GPA, and TEAS total score
predicted academic and NPTE success for PTA students.
Results from research completed by Aldridge et al. (2010) indicated that there was a
moderate positive relationship and a significant difference with scaled scores on the NDRT and
the NPTE. These authors concluded that the NDRT is a variable that has the potential to predict
first-time pass rates on the NPTE, and they recommended that the relationship of the NDRT and
the NPTE be investigated in graduate-level programs. As a part of their recommendation, this
study was designed to investigate the relationship between the NDRT and NPTE and the extent
to which the NDRT could predict NPTE success for DPT students. In contrast to the study by
Aldridge et. al, little relationship was demonstrated between the NDRT and NPTE; the NDRT
was not a significant variable, and the NDRT could not predict first-time success on the NPTE.
One possible reason for the varying results between the two studies was the change in program
status. When Aldridge et. al used the NDRT as a predictor variable, the PT program at Arkansas
State University was a master’s-level program. For the current study, the PT program is a
doctoral level program. Another possible difference in the results was the sample size. Whereas
this study was comprised of 45 subjects, the study by Aldridge et. al included 67 subjects.
Huhn and Parrott (2017) concluded that the HSRT improved the model for predicting
success in a DPT program and on the NPTE. Because of the results of the study by Huhn and
Parrott, the HSRT was used to determine if it could strengthen the model to predict first-time
pass success on the NPTE for the DPT program at Arkansas State University. In contrast to the
results of the study conducted by Huhn and Parrott, the HSRT did not predict success on the
NPTE for DPT students at Arkansas State University. Sample size could potentially be the cause
86
of conflicting results from these two studies. Huhn and Parrott used 160 students; this research
study consisted of only 45 subjects.
Although neither the NDRT nor the HSRT predicted first-time success on the NPTE,
program GPA was a predictor variable of first-time success on the NPTE for the DPT program at
Arkansas State University. Therefore, program GPA should be considered a predictor of first-
time success on the NPTE for DPT students. The results obtained in this study are consistent
with other studies found in the literature regarding program GPA as a predictor of NPTE success.
One example of the relationship of program GPA and NPTE success was evident in the study
that was conducted by Kosmahl (2005); the conclusion was academic performance in PT
programs is related to NPTE success. The results of the study conducted by Fell et al. (2015) also
established the relationship between GPA and NPTE and indicated that professional GPA
accounted for the greatest amount of variability for NPTE pass rate. In addition, the results of the
study by Luedtke-Hoffmann et al. (2012) demonstrated that GPA should be considered a strong
predictor of NPTE success. Based on the results of this study and other confirmatory studies,
students with a lower program GPA should consider being remediated prior to taking the NPTE.
To determine the relationship among reading ability, textbook readability, and the NPTE,
Keith et al. (2014) collected data from 161 graduates of the PTA program at Arkansas State
University from 2005 to 2014. They concluded that the NDRT should be used in combination
with other predictor variables to determine success on the NPTE. Since the suggestion was given
to combine the NDRT with other variables to predict success on the NPTE for PTA students, this
study investigated the effects of the NDRT, HSRT, and program GPA on NPTE success.
Although the NDRT is predictive of program success when used in conjunction with prerequisite
87
GPA, the NDRT does not predict first-time pass rate on the NPTE when the NDRT is used in
conjunction with the HSRT.
Program GPA was a predictor of first-time success on the NPTE. This confirms results
from a previous study. Desmarais et al. (2011) concluded that PTA GPA was the better predictor
of first-time pass rate success on the NPTE.
Historically, the HSRT has not been administered in the DPT or PTA programs at
Arkansas State University. Since the HSRT was significant and had a positive moderate
correlation, there should be consideration to continue administering this test to assist in
predicting first-time pass rates on the NPTE for PTA students.
Implications of the Research
Several implications apply to this study for research, theory, and practice. In determining
whether the NDRT and uGPA predict DPT program success, the results of this study proved that
the NDRT and uGPA are not predictors of success for the DPT program even though the NDRT
proved to be a predictor of program success at Arkansas State University for the master’s-level
PT program. The results of this study confirmed previous studies (Utzman et al., 2007a) that
suggest that programs should formulate their own predictor models. Because of the results of this
study, further studies should be completed to determine which measures might predict success in
the DPT program at Arkansas State University. Based on the results yielded in this study
regarding DPT program success, data suggest that the maintenance of a GPA of at least a 3.0
determines DPT program success at Arkansas State University. Students who fall below a 3.0
GPA are placed on academic probation and have the risk of not being successful in the DPT
program. Therefore, early remediation should be implemented for DPT students to decrease the
likelihood of being placed on academic probation and not being successful in the program.
88
Remediation can be suggested prior to taking the first examination in courses. Students who need
to be remediated early can be identified in several ways including the evaluation of their
performance on quizzes and in the laboratory. Furthermore, to assist students who have academic
difficulty in being successful in the DPT program, faculty can implement academic strategies
that have been effective for previous students.
A predictor model was established for PTA program success. The model suggested that
the implementation of a selective applicant process and the incorporation of the NDRT as a part
of the admissions criteria were beneficial in predicting students who would successfully
complete and graduate from the PTA program at Arkansas State University. The results also
suggested that reading comprehension and prerequisite or foundational courses, such as Anatomy
and Physiology I, Psychology, and Physics, determine success in the PTA program. Practically,
students who are considering the PTA program at Arkansas State University should be advised to
improve their reading comprehension skills and seek early remediation in prerequisite courses in
which they have difficulty. Also, other PTA programs should consider the implementation of a
reading comprehension test, NDRT, and prerequisite GPA as a part of their admissions process.
The prediction of success on the NPTE confirmed past literature that program GPA is a
predictor of success on the NPTE for both DPT and PTA students. To improve their likelihood
of success on the NPTE, DPT and PTA students should focus on coursework presented in their
respective programs and strive for higher program GPAs. Students who have difficulty in
courses and lower GPAs should be tutored and remediated prior to taking the NPTE. For
example, board preparatory courses can be one means of tutoring for students with lower
program GPAs. Reviewing study guides and board preparatory books are other methods of
remediation.
89
The HSRT was another predictor in the model of success on the NPTE for PTA students.
The incorporation of the HSRT provided a larger variation in the dependent variable and should
be considered a predictor variable of success on the NPTE for PTA students in programs using
the HSRT. The results of this model suggest that critical thinking skills are vital for PTA
students to possess. Because critical thinking skills are important for PTA students based on this
predictor model, PTA students should focus on possessing the following critical thinking skills:
evaluation, inference, deductive reasoning, inductive reasoning, and analysis. If PTA students are
deficient in any of these skills, they should develop strategies and seek remediation in improving
these skills.
In conclusion, once DPT students at Arkansas State University are admitted into the DPT
program, they should be cognizant that maintaining a higher GPA not only maintains their
position in the cohort, but having a higher program GPA increases the likelihood of first-time
success on the NPTE. Students who are admitted into the PTA program at Arkansas State
University should be aware that the likelihood of their succeeding in the PTA program is high
because of the program selectivity process; they should be aware that the higher their program
GPA and HSRT score are the more likely they will pass the NPTE on the first attempt.
Recommendations
To generalize the results to other DPT and PTA programs, this study should be replicated
with a larger sample size and at other universities and community colleges that use the NDRT,
the HSRT, and GPA to predict success in programs and on the NPTE. Studies for DPT and PTA
programs in other geographical locations should be completed to determine if location has an
influence on whether a relationship exists between the HSRT and the NPTE. Not only should
other DPT and PTA programs be examined, but other health care programs, such as doctor of
90
occupational therapy and occupational therapist assistant programs, should also be examined to
determine if these variables could predict program success and first-time board pass rate. Further
investigation should be completed to determine whether a minimum score exists on the HSRT
that may predict success on the NPTE for PTA students. Also, using the subscales of the HSRT
to determine whether the subscales can predict success on the NPTE should be investigated.
Furthermore, an alteration in the time of HSRT administration and the number of times that the
test is administered should be considered. Because the HSRT was a part of the predictor model,
there should be consideration of testing prior to final clinical rotations; earlier testing could allow
PTA students to receive earlier remediation.
In conclusion, this study both confirmed and denied the results of other studies on
program and NPTE success. This study was beneficial in providing new evidenced-based
research on program and NPTE success and on assessment of the value of GPA and tests, such as
the NDRT and HSRT, used in the DPT and PTA programs at Arkansas State University. Results
from this study indicated that a prediction equation for PTA success and a prediction equation
for NPTE success for DPT and PTA students were established. Impact, study design, and
statistical limitations were identified, and delimitations were explained. Future studies that
replicate this study should attempt to address the limitations and delimitations noted in this
study. Furthermore, theoretical and practical implications were discussed, and recommendations
were made for future research.
91
REFERENCES
92
REFERENCES
Aldridge, R. L., Keith, B., Sloas, S., & Mott-Murphree, A. (2010). Relationship of the
Nelson Denny Reading Test to scores on the National Physical Therapy Licensure
Examination. Journal of Allied Health, 39(2), 72-75.
American Physical Therapy Association. (2015a). Licensure. Retrieved from
https://www.apta.org/Licensure/
American Physical Therapy Association. (2015b). Physical therapist (PT) education overview.
Retrieved from http://www.apta.org/PTEducation/Overview/
American Physical Therapy Association. (2015c). Physical therapist assistant (PTA) education
overview Retrieved from http://www.apta.org/PTAEducation/Overview/
American Physical Therapy Association. (2017). Physical therapist centralized application
service 2015-2016 Applicant Data Report. Arlington, VA: Physical Therapist Centralized
Application Service.
Arkansas State University. (n.d.-a) Program statistics. Retrieved from
http://www.astate.edu/college/conhp/degrees/degree-details.dot?mid=c9bc5250-4190-
49e3-962f-e9e756774ee9
Arkansas State University. (n.d.-b). PT accreditation. Retrieved from
http://www.astate.edu/college/conhp/departments/physical-therapy/pt-accreditation/
Brill-Edwards, P., Couture, L., Evans, G., Hamilton, P., Hramiak, I., Megran, D., . . . Norman, G.
(2001). Predicting performance on the Royal College of Physicians and Surgeons of
93
Canada internal medicine written examination. Canadian Medical Association, 165(10),
1305-1307.
Brown, J. I., Fishco, V. V., & Hanna, G. (1993). Nelson-Denny Reading Test. Chicago, IL:
Riverside.
Brown, T. E., Reichel, P. C., & Quinlan, D. M. (2011). Extended time improves reading
comprehension test scores for adolescents with ADHD. Open Journal of
Psychiatry, 1, 79-87. doi:10.4236/jsemat.2011.13014
Brudvig, T. J., & Macauley, K. (2015). Clinical decision making tool for DPT students.
AcademicExchange Quarterly, 19(2). Retrieved from
http://rapidintellect.com/AEOweb/557915.pdf
Brudvig, T. J., Macauley, K., & Segal, N. (2017). Measuring clinical decision-making
and clinical skills in DPT students across a curriculum. Journal of Allied Health, 46(1),
21-25.
Brudvig, T. J., Mattson, D. J., & Guarino, A. J. (2015). Critical thinking skills and
learning styles in physical therapists trained in India enrolled in a master’s
program. Journal of Physical Therapy Education, 29(4), 5-13.
Brudvig, T. J., Mattson, D. J., & Guarino, A. J. (2016). Critical thinking skills and
learning styles in entry-level doctor of physical therapy students. Journal of
Physical Therapy Education, 30(4), 3-10.
Chambers, S. K., Munday, R., Sienty, S. F., & Justice, M. (1999). Predictors of success on the
Texas state certification tests for secondary teaching. College Student Journal, 33(1), 10-
15.
94
Coleman, C., Lindstrom, J., Nelson, J., Lindstrom, W., & Gregg, K. N. (2010).
Passageless comprehension on the Nelson-Denny Reading Test: Well above
chance for university students. Journal of Learning Disabilities, 43(3), 244-249.
Commission on Accreditation in Physical Therapy Education. (2014a). Evaluative criteria for
accreditation of PT programs. Retrieved from
http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accredi
tation_Handbook/EvaluativeCriteria_PT.pdf
Commission on Accreditation in Physical Therapy Education. (2014b). Evaluative criteria for
accreditation of PTA programs. Retrieved from
http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accredi
tation_Handbook/EvaluativeCriteria_PTA.pdf
Commission on Accreditation in Physical Therapy Education. (2017). Importance of CAPTE
accreditation. Retrieved from
http://www.capteonline.org/WhatWeDo/ImportanceofAccreditation/
Commission on Accreditation in Physical Therapy Education. (2018a). Aggregate program data
2018-2019 physical therapist assistant education programs fact sheets. Retrieved from
http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Aggreg
ate_Program_Data/AggregateProgramData_PTAPrograms.pdf
Commission on Accreditation in Physical Therapy Education. (2018b). Aggregate program data
2018-2019 physical therapist education programs fact sheets. Retrieved from
http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Aggreg
ate_Program_Data/AggregateProgramData_PTPrograms.pdf
95
Cook, C., Engelhard, C., Landry, M. D., & McCallum, C. (2015). Modifiable variables
in physical therapy education programs associated with first-time and three-year
National Physical Therapy Examination pass rates in the United States. Journal of
Educational Evaluation for Health Professions, 12(44), 1-8.
Cook, C. E., Landry, M. D., Covington, J. K., McCallum, C., & Engelhard, C. (2015).
Scholarly research productivity is not related to higher three-year licensure pass rates for
physical therapy academic programs. BioMed Central Medical Education, 15(1), 148-
154.
Cox, W. C., & McLaughlin, J. E. (2014). Association of Health Sciences Reasoning Test
scores with academic and experiential performance. American Journal of
Pharmaceutical Education, 78(4), 1-5.
Cox, W. C., Persky, A., & Blalock, S. J. (2013). Correlation of the Health Sciences
Reasoning Test with student admission variables. American Journal of
Pharmaceutical Education, 77(6), 118.
Desmarais, L., Woble-Valenski, M. A., & Oestmann, E. (2011). Factors influencing
physical therapist assistant licensure examination success. Journal of Physical
Therapy Education, 25(2), 36-41.
De Virgilio, C., Yaghoubian, A., Kaji, A., Collins, J. C., Deveney, K., Dolich, M., . . .
Waxman, K. (2010). Predicting performance on the American Board of Surgery
Qualifying and Certifying Examinations. Archives of Surgery, 145(9), 852-856.
Ennulat, C. W., Garrubba, C., & DeLong, D. (2011). Evaluation of multiple variables
predicting the likelihood of passage and failure of PANCE. Journal of Physician
Assistant Education, 22(1), 7-18.
96
Facione, N. C., & Facione, P. A. (1996). Externalizing the critical thinking in knowledge
development and clinical judgment. Nursing Outlook, 44(3), 129-136.
Federation of State Boards of Physical Therapy. (2017). National physical therapy examinations
[Brochure]. Retrieved from www.fsbpt.org
Fell, N., Mabey, R., Mohr, T., & Ingram, D. (2015). The preprofessional degree: Is it a
predictor of success in physical therapy education programs? Journal of Physical
Fernandez, A. R., Studnek, J. R., & Cone, D. C. (2009). The association between
Emergency Medical Technician-Basic (EMT-B) exam score, length of EMT-B
certiﬁcation, and success on the national paramedic certiﬁcation exam. Academic
Emergency Medicine, 16(9), 881-886.
Galleher, C., Rundquist, P. J., Barker, D. B., & Chang, W.-P. (2012). Determining cognitive
and non-cognitive predictors of success on the National Physical Therapy Examination.
Journal of Allied Health Sciences and Practice, 10(4), 1-10.
Gilliland, S. (2014). Clinical reasoning in first- and third-year physical therapist students.
Journal of Physical Therapy Education, 28(3), 64-80.
Gresham, B. B., Thompson, M., Luedtke-Hoffmann, K., & Tietze, M. (2015).
Institutional and program factors predict physical therapist assistant program
graduation rate and licensure examination pass rate. Journal of Physical Therapy
Education, 29(4), 27-36.
Guffey, J. S. (2000). The relative value of cognitive and non-cognitive variables as
predictors of scores on the physical therapy licensing examination (Doctoral
dissertation). Retrieved from http://www.astate.edu/a/library
97
Harrelson, G. L., Gallaspy, J. B., Knight, H. V., & Leaver-Dunn, D. (1997). Predictors of
success on the NATABOC certification examination. Journal of Athletic
Training, 32(4), 323-327.
Haught, P. A., & Walls, R. T. (2002). Adult learners: New norms on the Nelson-Denny
Reading Test for healthcare professionals. Reading Psychology, 23(3), 217-238.
Haught, P. A., & Walls, R. T. (2004). Relationships of reading, MCAT, and USMLE Step
1 test results for medical students. Reading Psychology, 25(2), 83-92.
Higgins, B. (2005). Strategies for lowering attrition rates and raising NCLEX-RN pass
rates. Journal of Nursing Education, 44(12), 541-547.
Huhn, K., Black, L., Jensen, G. M., & Deutsch, J. E. (2011). Construct validity of the
Health Science Reasoning Test. Journal of Allied Health, 40(4), 181-186.
Huhn, K., Black, L., Jensen, G. M., & Deutsch, J. E. (2013). Tracking change in
critical-thinking skills. Journal of Physical Therapy Education, 27(3), 26-31.
Huhn, K., & Parrott, J. S. (2017). Exploration of relationships among the Health Sciences
Reasoning Test, the National Physical Therapy Licensing Examination, and
cognitive admission variables. Journal of Physical Therapy Education,
31(1), 7-13.
Ingram, D., Mohr, T., & Mabey, R. (2015). Testing accommodations: Implications for
physical therapy educators and students. Journal of Physical Therapy Education,
29(1), 10-18.
Insight Assessment. (2017). Health sciences reasoning test: User manual. San Jose, CA: The
California Academic Press.
98
Jackson, J. R., & Brooks, C. M. (1985). Relationships among the MCAT reading subtest,
Nelson-Denny Reading Test, and medical school achievement. Journal of
Medical Education, 60(5), 478-480.
Kabiri, L. S., Voight, M., Gleeson, P. B., & Mitchell, K. (2017). Predicting academic and
licensure examination success among physical therapist assistant students. Journal of
Keith, B., Sloas, S. B., Mooney, M., & Norris, T. (2014). Readability of PTA textbooks
and reading comprehension rates of PTA students. International Association for
Research on Textbooks and Educational Media e-Journal, 6(1), 37-47.
Kosmahl, E. M. (2005). Factors related to physical therapist license examination scores.
Luedtke-Hoffmann, K., Dillon, L., Utsey, C., & Tomaka, J. (2012). Is there a
relationship between performance during physical therapist clinical education and
scores on the National Physical Therapy Examination (NPTE)? Journal of
Maring, J., & Costello, E. (2009). Education program and student characteristics
associated with pass rates on the National Physical Therapy Examination for
physical therapist assistants. Journal of Physical Therapy Education, 23(1), 3-11.
Maring, J., Costello, E., Ulfers, M., & Zuber, E. (2013). Curriculum, faculty, and
cohort variables predicting physical therapist assistant program graduate success
on the National Physical Therapy Examination. Journal of Physical Therapy
Education, 27(2), 33-40.
99
Markert, R. (1985). Relationship of old and new MCAT scores to performance on the
Part III examination of the NBME. Journal of Medical Education, 60(1), 53-55.
Masterson, J., & Hayes, M. (2004). UK data from 197 undergraduates for the Nelson
Denny Reading Test. Journal of Research in Reading, 27(1), 30-35.
McCaskill, Q. E., Kirk, J. J., Barata, D. M., Wludyka, P. S., Zenni, E. A., & Chiu, T. T.
(2007). USMLE Step 1 scores as a significant predictor of future board passage in
pediatrics. Ambulatory Pediatrics, 7(2), 192-195.
Middlemas, D. A., Manning, J. M., Gazzillo, L. M., & Young, J. (2001). Predicting
performance on the national athletic trainers’ association board of certification
examination from grade point average and number of clinical hours. Journal of
Athletic Training, 36(2), 136-140.
Mitchell, A. W., & Xu, Y. J. (2011). Critical reasoning scores of entering bachelor’s and
master’s students in an occupational therapy program. American Journal of
Occupational Therapy, 65(6), e86-e94.
Mohr, T., Ingram, D., Hayes, S., & Du, Z. (2005). Educational program characteristics and
pass rates on the National Physical Therapy Examination. Journal of Physical
Paans, W., Sermeus, W., Nieweg, R. M. B., Krijnen, W. P., & van der Schans, C. P.
(2012). Do knowledge, knowledge sources and reasoning skills affect the
accuracy of nursing diagnoses? A randomized study. BioMed Central Nursing, 11(11), 1-
12.
100
Paans, W., Sermeus, W., Nieweg, R. M. B., & Van Der Schans, C. P. (2010). Determinants of
the accuracy of nursing diagnoses: Influence of ready knowledge, knowledge sources,
disposition toward critical thinking, and reasoning skills. Journal of Professional
Nursing, 26(4), 232-241.
Riddle, D. L., Utzman, R. R., Jewell, D. V., Pearson, S., & Kong, X. (2009). Academic
difficulty and program level variables predict performance on the National Physical
Therapy Examination for licensure: A population-based cohort study. Physical Therapy,
89(11), 1182-1191.
Roehrig, S. M. (1988). Prediction of licensing examination scores in physical therapy
graduates. Physical Therapy, 68(5), 694-698.
Rollins, L. K., Martindale, J. R., Edmond, M., Manser, T., & Scheld, W. M. (1998).
Predicting pass rates on the American Board of Internal Medicine certifying
examination. Journal of General Internal Medicine, 13(6), 414-416.
Romeo, E. M. (2013). The predictive ability of critical thinking, nursing GPA, and SAT
scores on first-time NCLEX-RN performance. Nursing Education Perspectives,
34(4), 248-253.
Runyan, M. K. (1991). The effect of extra time on reading comprehension scores for
university students with and without learning disabilities. Journal of Learning
Disabilities, 24(2), 104-108.
Sanderson, T. R., & Lorentzen, M. H. (2015). Exploring preadmission criteria as
predictors for dental hygiene licensure examination pass rates. The Journal of
Dental Hygiene, 89(2), 101-108.
101
Sharp, M. Y., Reynolds, R. B., & Brooks, K. N. (2013). Critical thinking skills of allied
health science students: A structured inquiry. Retrieved from
http://eduperspectives.ahima.org/critical-thinking-skills-of-allied-health-science-students-
a-structured-inquiry/
Shellito, J. L., Osland, J. S., Helmer, S. D., & Chang, F. C. (2010). American Board of
Surgery Examinations: Can we identify surgery residency applicants and residents
who will pass the examinations on the first attempt? The American Journal of Surgery,
199(2), 216-222.
Shiyko, M. P., & Pappas, E. (2009). Validation of pre-admission requirements in a
Doctor of Physical Therapy program with a large representation of minority
students. Journal of Physical Therapy Education, 23(2), 29-36.
Sloas, S. B., Keith, B., & Whitehead, M. T. (2013). Use of a pretest strategy for physical
therapist assistant programs to predict success rate on the national physical
therapy exam. Journal of Allied Health, 42(2), 79-83.
Solberg, B. L. (2015). Critical thinking as a predictor of certification exam performance in
medical laboratory science. Clinical Laboratory Science, 28(2), 76-82.
Spurlock, D. R., & Hunt, L. A. (2008). A study of the usefulness of the HESI exit exam
in predicting NCLEX-RN failure. Journal of Nursing Education, 47(4), 157-
166.
Stevens, K. C. (1980). The effect of background knowledge on the reading
comprehension of ninth graders. Journal of Reading Behavior, 12(2), 151-154.
102
Texas, A. G., Mundy, M.-A., Varela, D., Ybarra, A., & Yuma, S. (2016, December). An analysis
of teacher candidate success as measured by admission requirements. Research in
Higher Education Journal, 31, 1-9. Retrieved from
http://aabri.com/manuscripts/162458.pdf
Truskowski, S. (2016). Exploring the relationship between entry-level master’s program
class size and the number of graduate credits offered and aggregate NBCOT pass
rates. The Open Journal of Occupational Therapy, 4(2), 1-11.
U. S. Department of Education. (2000). Title 34 education. Retrieved from
https://www2.ed.gov/policy/rights/reg/ocr/edlite-34cfr104.html#S43
Utley, C., Brown, S. R., & Robel, S. J. (2016). Effect of clinical experience on
comprehensive examination performance in a physical therapist education
program. Journal of Physical Therapy Education, 30(2), 38-44.
Utzman, R. R., Riddle, D. L., & Jewell, D. V. (2007a). Use of demographic and
quantitative admissions data to predict academic difficulty among professional
physical therapist students. Physical Therapy, 87(9), 1164-1180.
Utzman, R. R., Riddle, D. L., & Jewell, D.V. (2007b). Use of demographic and
quantitative admissions data to predict performance on the National Physical
Therapy Examination. Physical Therapy, 87(9), 1181-1193.
Vendrely, A. M. (2007). An investigation of the relationships among academic
performance, clinical performance, critical thinking, and success on the Physical
Therapy Licensure Examination. Journal of Allied Health, 36(2), e108-e123.
103
Wheeler, E., Finucane, S., Soper, S., & Mayhew, T. (2018). Perceived value of preadmission
physical therapy observation hours and their ability to predict academic performance.
104

The Prediction of National Physical Therapy Examination First-Time Pass Rates Using Reading Comprehension and Critical Thinking Skills Tests

Transféré par

Informations du document

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

The Prediction of National Physical Therapy Examination First-Time Pass Rates Using Reading Comprehension and Critical Thinking Skills Tests

Transféré par

Droits d'auteur :

Formats disponibles

UNION UNIVERSITY

We hereby recommend that the Dissertation by

LaToya LaTrice Green

Comprehension and Critical Thinking Skills Tests

Be accepted in partial fulfillment of the requirements for the Degree of

Dissertation Committee: John D. Foubert, Ph.D., Chairperson

James S. Guffey, PT, Ed.D.

Thomas R. Rosebrough, Ph.D.

Ed.D. Program Director: Ben T. Phillips, Ed.D.

Dean of the College: John D. Foubert, Ph.D.

Comprehension and Critical Thinking Skills Tests

Submitted in Partial Fulfillment of the Requirements for the

Doctor of Education Degree

LaToya LaTrice Green

I dedicate this manuscript to my husband, Marvin,

To my God-sent son, Lexington,

To my mother, Versie Nance,

whose sacrifice and encouragement enable me to achieve my dreams.

this doctoral program. I am indebted to my dissertation committee members for investing so

commitment to be my dissertation chair. I am grateful to Dr. Tom Rosebrough for his

when I was doubtful, and my cheerleader when I needed a vocal supporter.

2. REVIEW OF LITERATURE ............................................................................................12

5. CONCLUSIONS AND DISCUSSION .............................................................................80

1. Demographics for DPT Students in the Classes of 2017 and 2018…………...….……..70

2. Demographics for PTA Students in the Classes of 2017 and 2018…………...………...71

Physical Therapy Students………………………………………………………72

Physical Therapist Assistant Students…………………………………………..74

Therapist Assistant Students……………………………………………………75

Doctor of Physical Therapy Students ………………………………………….76

Physical Therapy Students……………………………………………………..77

Physical Therapist Assistant Students…………………………………………78

Therapist Assistant Students…………………………………………………...79

programs is increasing steadily. According to the Physical Therapist Centralized Application

University-Jonesboro campus, 30 applicants were selected from 79 applicants. Forty-two

the admissions process by attempting to identify applicants who would be successful in a PT

Background of the Problem

students who will be successful in medical school.

the American Board of Surgery in-Training Examination.

Zuber, 2013; Shiyko & Pappas, 2009; Wheeler et al., 2018).

To become accredited or maintain accreditation, DPT and PTA programs strive to

Aldridge et al., 2010; Keith et al., 2014).

Statement of Problem and Research Questions

reading and critical thinking ability.

on the NPTE for DPT students?

on the NPTE for PTA students?

Purpose of the Study

predict first-time pass rates on the NPTE.

therapy programs and first-time pass rates on the NPTE.

Significance of the Study

beyond memorizing and recalling information.

reasoning, and inductive reasoning.

National Physical Therapy Licensure Examination (NPTE). The NPTE is a national

comprehension, and fluency.

Assumptions, Limitations, and Delimitations of the Study

from the researcher than are PTA students.

This chapter will begin by outlining student requirements, summarizing qualifications,

Examinations (NPTE) will be discussed.

PT and PTA Requirements and Qualifications

requirements. Physical therapist assistant (PTA) candidates must be dedicated to completing

programs were $65,170, private programs were $112,714 (Commission on Accreditation in

Physical Therapy Education, 2018b).

“The purpose of PTA education is to graduate knowledgeable, competent, self-assured,

adaptable, and service-oriented patient/client care providers” (American Physical Therapy

The mission of PT professional education is to graduate knowledgeable, service-oriented,