CAPP Certificate Program

CAPP Physical Therapist (PT) Case Reflection Expectations

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A. Purpose and Mission of the CAPP Case Reflection

B. Recommendations for Writing the CAPP Case Reflection

C. Case Revisions and Resubmission

D. Return to CAPP Program Information

 

A. Purpose and Mission of the CAPP Case Reflection

The purpose of the CAPP Case Reflection is to serve as a capstone project to evaluate the physical therapist’s (PT’s) ability to synthesize their understanding of the CAPP curriculum for obtaining the CAPP certificate. PT candidates are required to demonstrate a culmination of their acquired knowledge, skills, and critical thinking processes obtained through the didactic and practical course instruction and testing.

The physical therapist (PT) chooses a patient whom they have evaluated and treated, and develops a professional paper in which the PT reflects on the patient’s specialized physical therapy from start to finish. The therapist demonstrates their ability to integrate coursework and current evidence into understanding and executing the treatment plan of a patient with a condition related to pregnancy or postpartum (CAPP-OB) or a pelvic condition (CAPP-Pelvic), including the ability to synthesize the patient’s subjective report, medical signs and symptoms, and PT evaluation including tests and measures. The patient’s physical therapy diagnosis(es), goals, and plan of care for the patient are outlined. The PT is to identify red flags, utilization of functional outcome tools, interventions, responses to treatment, progress, setbacks, and modifications. The reflection integrates current evidence as it relates to the patient’s condition, examination, and treatment to support the therapist’s clinical reasoning and decision-making. The therapist summarizes the patient’s cases by reflecting on how the skills learned in the CAPP education enhanced the PT’s contribution to the patient's physical therapy experience and outcome, and lessons learned from their patient’s care.

B. Recommendations for Writing the CAPP Case Reflection

1. Organize the paper in the same order and with the same section headings using bold font as in the CAPP PT Case Reflection Rubric, which is posted with the CAPP information on the Academy website. This allows reviewers to easily locate all required pieces of information. Case Reflection Reviewers will score your Case Reflection using this rubric. Subheadings to further clarify the inclusion of required information are optional.

  1. Create an appropriate, descriptive title for the Case Reflection 

    • Highlight the topic, an unusual outcome, or give insight into what the treatment plan is about 

  2. Identify if seeking CAPP-Pelvic or CAPP-OB

  3. Document the case submission date

EXAMPLE

PT Evaluation and Management of a Pregnant Ultra-Marathon Runner with Pelvic Girdle Pain

CAPP-OB

April 14, 2025

📄  NOTES

  • DO NOT INCLUDE YOUR NAME ON THE COVER PAGE OR ANYWHERE IN YOUR REFLECTION
  • All Reflections are blinded to reviewers

Required Sections

  1. Introduction and Patient History
  2. Examination (includes subsections Systems Review, Tests and Measures, and Outcome Tools)
  3. Evaluation/Diagnosis
  4. Prognosis/Plan of Care
  5. Intervention
  6. Outcomes
  7. Reflection
  8. References

📄 NOTES

  • Clearly label the required section headings on a separate line and in bold font.

  • You may include subheadings to further clarify the inclusion of required information.

  • Case Reviewers will score your case reflection using this rubric.

Introduction and Patient History
  1. Provide relevant history, including demographic characteristics and pertinent psychological, social, and environmental factors.

  2. Discuss contributing factors, precautions, or contraindications.

  3. Describe prior or current service,s as well as medical diagnostics and treatment related to the current episode of physical therapy. 

    • Ex: Manometry? Cystometry? MRI? Bed rest status?

  4. Include relevant medical diagnoses and medical/surgical history.

  5. Explain comorbidities that may affect the prognosis, anticipated goals, expected outcomes, and/or plan of care.

  6. Describe the patient’s desired outcomes.

  7. Include cultural considerations if pertinent.

  8. Describe functional status (past/present).

📄 NOTES

  • Avoid unclear passive tense “It is hypothesized that …”: by whom? If the author, then say so; if others, include citation and supportive reference. 
Examination

Include subsections Systems Review, Tests and Measures, and Outcome Tools

Systems Review

  1. Address any pertinent findings within the neuromuscular, cardiopulmonary, and integumentary systems.

  2. Fully describe musculoskeletal findings, even if unremarkable. 


Test and Measures

  1. Provide rationale for chosen tests (to confirm or reject hypotheses, support clinical judgments).

  2. Provide reasoning why testing positions were utilized if other than the standard position.

  3. Was pelvic exam consent received? Was it verbal, written?

  4. Provide commentary on the outcome tool(s) chosen, if appropriate

    • Ex: reliability, specificity, validity, sensitivity, and likelihood ratios.

  5. Explain findings in detail. 

    • What makes a test positive or negative? 

    • What do the results of special tests or other measures mean?

  6. If you modified a test, explain your rationale for the modification, and your rationale for what you interpret the results to mean.

📄 NOTES

  • Avoid statements such as “PFMs with poor tone externally” without further explanation of what is meant by this. 
  • “The patient had perineal descent.” What is this? Is this a normal finding? How was this measured or determined?
  • “Patient demonstrated positive testing with anterior vaginal wall and apical testing with bearing down”. What test was used? What was the grade?
  • “Pelvic floor muscle strength was 2/5.” What does this mean? How was a 2/5 grade determined? “Patient had (+) posterior pelvic pain provocation test on the right”. What does this indicate?
  • At this level of practice, it is expected that examination of pelvic floor disorders will include musculoskeletal screening. Describe these results, even if the findings were unremarkable. Provide an explanation if screening was not performed. 

Outcome Tools

  1. Describe the outcome tools used. Provide information on validity, specificity, sensitivity, and/or likelihood ratio of outcome tools when available.  If not available, state this.

  2. Explain what outcome scores mean. In other words, is a blood pressure of 150/90 mm Hg WNLs? What does a questionnaire score of 33 mean?

  3. If no outcome tool was used, discuss why and what was used instead as an outcome measure, or could have been used.

Evaluation/Diagnosis
  1. Provide a summary of findings.

  2. Consider dominant pain mechanisms, symptoms consistent with a particular syndrome, extent of impairments, functional limitations, and associated tissue changes.

  3. Provide explanation of decision making and rationale of examination findings from history, systems review, and tests and measures.

  4. Provide a hypothesis of the suspected cause of symptoms/diagnosis. Describe your thought process with differential diagnosis.

  5. Provide physical therapy diagnosis (es) 

    • i.e., “pelvic floor muscle weakness” versus medical diagnosis of “urinary incontinence”) as supported by current literature.

  6. Include a description of the differential diagnosis. 

Prognosis/Plan of Care
  1. Provide a list of patient-centered, objectively-measured, functional goals in a specific time period.

  2. Provide a prognosis for the patient to achieve established goals. 

  3. Describe your plan of care and explain what guided your decisions for PT interventions, referral to other practitioners, and frequency/duration of treatment.

📄 NOTES
  • Prognosis is based on literature and understanding the nature of the disorder, for instance, whether or not it is inflammatory, degrees of irritability, and course of recovery to date (whether worsening or improving). Prognosis is also based on precautions, patho-biological mechanisms, patient perceptions (i.e., cognitive/affective status), and contributing factors.  
  • Examples of poor vs. appropriate goals:
    • Poor: Strength will improve to 4/5.  (Whose strength, strength of what, how is strength measured, what is the timeframe to meet the goal, how does this relate to function?) Appropriate: Within 8 weeks, the patient will demonstrate improved levator ani muscle strength to 4/5 for reduced episodes of urinary continence. (This is patient-centered, specific to the strength of the pelvic floor, objectively measurable, and related to the function of continence within a specified time period of reaching the goal.)
    • Poor: Patient will report a decrease in pain. (What is the timeframe for meeting the goal, where is the pain, how is the pain reduction measured, how will the pain reduction relate to function?) Appropriate: Within 12 weeks, the patient will report right-sided pelvic girdle pain reduced to 2/10 or less on a numeric rating scale while lifting her baby into a stroller. (Patient-centered, specific to pelvic girdle pain, objectively measurable, and related to the daily function of placing the baby in a stroller within a specified timeframe of reaching the goal.)

Intervention

  1. Describe interventions in sufficient detail such that another clinician could replicate them.

  2. Provide the purpose for each chosen intervention and why you chose it. Support your choices with available evidence.

  3. How has the treatment and/or home exercise program progressed, and why? Relate to evidence.

  4. What topics were the patient/family educated in and why? Relate to evidence.

  5. Include communication with other health care providers.

  6. Were modifications necessary throughout the course of treatment? If so, why, and were modifications effective?

  7. Provide parameters of modalities and why these parameters were chosen.

  8. Describing each treatment session may be a way to capture the necessary details.

  9. Describe how risk factors and overall health promotion were addressed.

  10. Optional: Consider conveying this information in chart form to assure it is comprehensive, shows chronology of care, changes, and details for each session attended


📄 NOTES

  • “Treatment intervention included general and gynecological manual therapy, electrical therapy, NM ReEd, PF relaxation, as well as PF and core strengthening” is too vague and needs to be explained in detail.   
  • “Internal myofascial releases” is too vague.
  • “Pelvic floor and core strength were increased” or “exercises were progressed” needs to be explained.
  • “Gentle stretching of the walls of the vagina was performed.” Describe the technique.
  •  “The patient contracted her multifidus and transverse abdominus muscles.” Explain how the patient was instructed to do this. What exercises were provided, targeting which muscles, and why? Clearly describe exercises as they were instructed to the patient to ensure replicability. How many repetitions, sets, frequency of clinic and home exercises? Why were these parameters chosen? 

Outcomes

  1. What was the outcome of PT treatment? Compare measured outcomes with the patient's pretreatment status.

  2. Were goals met, or was progress made towards the patient's desired outcomes?

  3. Provide results of outcome tools and describe in your own words what the results mean.

  4. Describe patient adherence and how this impacted the outcome.

  5. Provide a number of treatments administered in a specific time frame.

  6. If goals, frequency, or duration were adjusted during the course of treatment, explain why.  

📄 NOTES

  • “PFM tone was reduced upon discharge from PT.” Objective data within the case must support this statement. 

Reflection 

  1. Summarize a reflection of your case.

  2. Describe barriers encountered during treatment and how they may have impacted the patient’s outcome.

  3. Was there a better outcome tool you would use in the future? Support your choice.

  4. Describe clues that were missed, under- or over- weighted.

  5. What did you learn from this case, and what might you do differently?

  6. Explain how understanding the patient’s problem changed your management in subsequent visits.

  7. How was the outcome managed if less than 100% was resolved?

  8. Include relevant administrative, financial, and psycho-social implications.

  9. How were the patient’s needs met or not met?

  10. How did this case relate to other cases or reports in the literature, if applicable? Reflect on the differences between your case and others you’ve treated. 


References

  1. Provide in AMA and APA format as described above.

  2. Follow the criteria as listed in #6 and #7 below. 

2. Develop a quality Case Reflection at a professional/post-graduate level.

  • Use accepted English syntax, grammar, spelling, consistent tense, and punctuation.

  • Use full sentences and paragraphs throughout the paper. It is unacceptable to use bullet point formatting, shorthand, and abbreviations, and it should not resemble clinic notes.

  • The first time an acronym is used, it must be defined (e.g., DRA, PFM, SUI).

  • Ask a colleague familiar with the English language to proofread and provide feedback on the readability and professionalism of your paper before submission, especially if English is not the author’s first language.

  • Treatment plans that are difficult to read because of formatting, syntax, grammar, spelling, and punctuation will automatically be returned for revision.

3. The submitted paper will be critiqued using the CAPP Case Reflection Rubric and will fail to pass if items on the rubric are not adequately addressed. For instance, if no barriers to treatment existed, the author must clearly state that barriers did not exist and further explain as appropriate. Use the rubric and this “Expectations” document when developing your paper to ensure each required item on the rubric is included in the paper, and reviewers can see the necessary information.

4. Plagiarism is unacceptable. As with any professional writing, information used word-for-word from another source is to be placed in quotes with a footnote citing the source. Background information is expected to be integrated from appropriate sources and rewritten in your own words as it pertains to your subject, giving credit to the sources of ideas expressed. It is not acceptable to place large blocks of copied information within your Reflection, even if referenced. Please review the article explaining types of plagiarism at www.plagiarism.org for clarification. The plagiarism policies a student follows in an academic institution continue to be pertinent to the professional physical therapist. 

5. Use standardized medical terminology. If quoting a reference that uses outdated terminology, the author should provide an explanation of updated terminology following the quote. (E.g., “excessive tension of pelvic floor muscles” rather than “muscle spasm.”)

6. Cite references throughout the paper and in a References List at the end of the paper according to either the American Medical Association (AMA) or American Psychological Association (APA) style. Be consistent in using one format only. AMA and APA style formats can easily be reviewed on the internet. Here are examples of how to make your references consistent throughout the paper:

7. Select references from recognized scientific, primarily peer-reviewed sources.

  • Include references throughout the Reflection for evidence of claims being made, to acknowledge the work of others, and to convey whether the PT chose treatments that are or are not supported by evidence.

  • References from peer-reviewed sources are required to be from within the last 10 years, unless a seminal study. As a guide, most well-written reflections contain 20 or more references to adequately address evidence-based care.

  • Using internet references from reputable sources such as government or professional organizations (ACOG, AMA, CDC) is acceptable, as is locating a peer-reviewed journal article. It is not acceptable to use sources such as Wikipedia, websites, or blogs for background information.

  • Quoting a course instructor or a course is not an appropriate reference, however, a specific article or publication can be cited from a course manual. Locate and read the scientific literature before referencing.

8. Graphs, charts, tables, and graphics are encouraged, but optional, as they can help to convey and simplify data and interventions.

  • Place within the body of the document or as an appendix.

9. Include commentary throughout the Reflection to help the reviewer understand the PT’s thought process and clinical reasoning.

  • Share your knowledge and insights with the reader so that it is clear to the reader that you understand what you are writing.

  • If helpful in organizing your paper, include inserted/boxed sections titled Reflections to provide your opinion and explanation of thoughts/decisions.

10. Provide details, particularly regarding chosen interventions and rationale as it relates to current practice/literature.

11. Clearly explain medical terms used. Write as if your reader is not familiar with orthopedic, obstetric, or pelvic terminology. For example, explain conditions such as “force closure,” a “R upslip,” or “short pelvic floor”. Clearly describe findings using current standardized terminology.

12. Clearly describe and/or define terminology pertaining specifically to obstetric or pelvic specialty practice, including terms related to diagnosis and medical terminology.

  • E.g., define/describe PFM MMT 2/5 or P2G2A, so a PTA or PT not in the specialty practice can understand the terminology and descriptions clearly in the Reflection.

13. Safeguard a patient’s identity according to HIPAA guidelines. Do NOT cut and paste from the patient’s electronic record. Rewrite pertinent patient information without using unique identifiers that would put a patient’s identity at risk. Using initials to refer to the patient is acceptable.

14. Focus the paper’s attention on pelvic health physical therapy if seeking CAPP-Pelvic and obstetric physical therapy if seeking CAPP-OB. For example, if the case reflection is for CAPP-OB, the paper’s focus should be on the material learned (outcomes, interventions, evidence) in the CAPP-OB curriculum, and NOT on internal treatment of the pelvic floor. Choose a patient who allows you to highlight your knowledge and skills in specialty practice for the certification you are seeking.

15. Note that for the Reflection to receive a passing score, all components of each section of the rubric must receive a passing score. 

16. PTs intending to seek both CAPP-OB and CAPP-Pelvic must complete individual applications for each and submit different Reflections describing the physical therapy specialty care of two DIFFERENT patients. Each Reflection submitted must describe patients with different diagnoses.

 

C. Case Revision & Resubmission

Results are provided to CAPP candidates via email. Candidates should not be concerned if their results request a revision of their Reflection. The PT CAPP Case Reflection is part of the overall learning process, and performing revisions often enriches the learning experience.

STEPS

  1. Resubmitting a revised Case Reflection must be within 6 months from the date of the results notification letter. If an extension for additional time is needed, make a request at CAPP Case Extension Request Form.
  2. When revising your paper, use the feedback provided in both rubrics to determine specifically which sections and items need revision or more information. Comments and rubric sections marked “No” will be critiqued when the Reflection is resubmitted. Edit the original paper; there is no need to completely rewrite the paper.
  3. After revisions are complete, resubmit your Case Reflection to the Academy of Pelvic Health at: CAPP Case Revision Submission Form. Refer to your results notification letter on how to resubmit.
    • Indicate on the Cover Page that the Reflection is a REVISION
    • Date according to the resubmission date
  4. Your resubmitted Reflection will be reviewed, a new rubric completed, and you will receive notification if the Reflection needs further edits or adequately meets the criteria needed to pass the Case Reflection.