Journal of Geriatric Physical Therapy最新文献

Background: In skilled nursing facilities (SNFs), i-STRONGER is a novel, high-intensity resistance training approach that incorporates progressive resistance training to promote greater improvements in patient function compared to usual care. To inform large-scale expansion of i-STRONGER as standard-of-care in SNFs, this mixed-methods study assessed rehabilitation providers' perceptions of i-STRONGER and purported needs for its adoption.

Methods: Forty-three rehabilitation providers participated in an 18-week, interactive i-STRONGER training program. Post-training, the validated Perceived Characteristics of Intervention Scale was used to evaluate i-STRONGER relative advantage, compatibility with practice, complexity, potential for reinvention (ie, adaptability), trialability, and risk. Providers reported the top 3 needs for successful i-STRONGER adoption and described i-STRONGER perceptions in training modules and focus groups. A convergent mixed-methods design was used to evaluate and describe clinician perceptions of i-STRONGER.

Results: i-STRONGER program conceptually aligned with providers' practice. The patterns and was endorsed as feasible and adaptable as part of patient care; however, initial hesitancies surrounding patients' physical abilities and motivation were noted as barriers and appeared to reflect negative age-related beliefs and attitudes within SNF cultures. Providers feared patients would be unwilling or unable to engage with i-STRONGER activities due to their age, deconditioning, medical complexity, or expectation that rehabilitation should feel "easier." As providers began implementing i-STRONGER in real-time, concerns surrounding i-STRONGER's potential risks lessened as providers observed improvements in patient function and motivation, and patients were described as "embracing" i-STRONGER principles. Patient acceptance and satisfaction, equipment, time, and clear communication among providers were cited as critical needs for i-STRONGER adoption.

Conclusions: With i-STRONGER, a safe and effective approach for delivering resistance training to older adults in SNF settings, "seeing is believing." Real-time implementation of i-STRONGER facilitated an evolution of perspective among providers, fueled by observable, positive changes in patient function and affect as well as unexpected patient participation. Findings support i-STRONGER use in SNF settings, provided that specific training strategies showcase older adults with medical complexity participating in progressive resistance training.

Background and purpose: Approximately, 30% to 60% of older adults experience functional decline following hospitalization, which has implications for their ability to meet social needs after discharge. Exploring the unmet social needs of older adults following discharge is warranted to rethink the elements of hospital discharge in low-resource countries. This study explored the unmet social needs of older adults with mobility limitations following discharge from an inpatient rehabilitation unit in a state hospital in Northern Nigeria.

Methods: This narrative qualitative study is based on the social constructivism paradigm guided by the 3-Dimensional Narrative Inquiry Space (3-D NIS) methodology. We purposively selected and conducted telephone interviews with 12 older adults, aged 55 years and older, with mobility limitations and discharged from inpatient rehabilitation units. The 3-D NIS guided the thematic analysis of the data. Two author coders independently conducted a thematic analysis of the transcripts. Reflexivity was maintained throughout the research process.

Results and discussions: Two related themes [6 sub-themes] emerged: "limitations in social functioning" [leisure activity, religious engagement, and instrumental activities of daily living modifications]; and "accepting the status quo" [Care/support from relatives, friends, and strangers, regrets and aspirations, and adaptation to psychological needs]. Seven tensions from the participants' transcripts were embedded in emotions, focused on belief, well-being, and spirituality, COVID-19 pandemic impact, desire to be "normal," limited finance, non-age-friendly homes and community settings, and undetailed rehabilitation discharge planning.

Conclusion: This study highlights the substantial unmet social needs of older adults with mobility limitations following discharge from inpatient rehabilitation units in Northern Nigeria, underscoring the importance of a holistic approach to hospital discharge planning. Future research in low-resource countries should delve deeper into developing comprehensive discharge strategies that integrate social workers and rehabilitation professionals to effectively address these multifaceted social needs.

Background and purpose: Physical therapists play a vital role in preventing and managing falls in older adults. With advancements in digital health and technology, community fall prevention programs need to adopt valid and reliable telehealth-based assessments. The purpose of this study was to evaluate the validity and reliability of the telehealth-based timed up and go (TUG) test, 30-second chair stand test (30s-CST), and four-stage (4-stage) balance test as functional components of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk assessment.

Methods: This cross-sectional study was conducted using a convenience sample of community-dwelling older adults. The TUG, 30s-CST, and 4-stage balance test were administered in random order in 1 session in the participant's own environment. Performance was scored concurrently by an in-person and synchronous telehealth rater. The video recordings of the performances were scored by an asynchronous telehealth rater on days 1 and 30 for inter- and intra-rater reliability. Additionally, participants performed the TUG test twice, using the distance measured by the participant and the distance measured by the in-person rater. To establish the validity of telehealth-based STEADI fall risk assessments, the Intraclass Correlation Coefficient (ICC), Pearson correlation coefficient, and 95% limits of agreement were derived. Inter- and intra-rater reliability were established by calculating ICC using a 2-way mixed model. Bland-Altman plots were created for nonsignificant proportional bias tests.

Results and discussion: Thirty community-dwelling older adults participated. Based on the STEADI algorithm, 13 participants were classified as having a moderate fall risk. A comparison of in-person and synchronous telehealth ratings showed excellent ICCs (0.97-0.99) and relationships (r = 0.94-0.98). Bland-Altman plots were created for all tests except for the 30s-CST (t = -2.168, P = .04). All tests had good to excellent inter-rater reliability (ICC = 0.84-1.00) and intra-rater reliability (0.77-1.00). No adverse events were reported.

Conclusion: This study suggests that telehealth-administered functional tests in the STEADI fall risk assessment are valid and reliable when technology, environment, camera view, and angle are optimally managed.

Background and purpose: The objective was to examine the adjuvant effect of active pulsed electromagnetic field (PEMF) versus microwave (MW) therapy, as well as sham PEMF, in addressing pain and improving functionality for treating knee osteoarthritis (KOA).

Methods: This was a double-blind, placebo-controlled, randomized clinical trial. Individuals diagnosed with KOA were assigned to an intervention combining an exercise program (EX) with active PEMF, MW, or sham PEMF. The main outcomes were pain, reported on a visual analogue scale (VAS), and functionality, assessed using the Western Ontario and McMaster Universities Arthritis (WOMAC) questionnaire, and the Timed Up and Go test (TUG). The outcomes were measured preintervention, immediately postintervention, and at 1 and 4 months of follow-up (FU).

Results: Sixty individuals (n = 83 knees) were evaluated. Significant between-group differences were found in WOMAC stiffness (rmMANOVA (F(2,77) = 4.33, P = .017, partial η2 = 0.10)). A notable interaction effect between group and time was found for the WOMAC pain score (rmMANOVA (F(2, 77) = 3.14, P = .049, partial η2 = 0.07)). After 4 months, the PEMF + EX group demonstrated superior pain relief compared to the sham PEMF + EX (WOMAC pain "mean difference ± standard error between-groups": -3.2 ± 1.2, P = .028) and MW + EX (VAS pain: -2.1 ± 0.9, P = .042) groups. PEMF + EX perceived less stiffness than did the sham PEMF + EX in both the pre-FU (WOMAC stiffness: -1.6 ± 0.6, P = .047), 1-month FU (-1.7 ± 0.6, P = .015) and 4-month FU (-1.4 ± 0.6, P = .038), with no changes in the MW + EX group. WOMAC function score showed greater improvement in the PEMF + EX group compared to the MW + EX group at 4-month of FU (-9.0 ± 3.6, P = .039). Only PEMF + EX showed a positive effect on the TUG score at 1-month FU (-1.7 ± 0.5, P = <.001) and 4-month of FU (1.9 ± 0.5, P = .020).

Conclusions: The application of PEMF could be a useful adjuvant treatment to exercise programs to further decrease pain and improve knee stiffness and function in individuals with KOA in the medium term compared to MW and sham PEMF.

Background: Despite the promise wearable technology offers through detailed insight into mobility and fall risk, timely identification of high risk, assessment of risk severity, evaluation of clinical interventions, and potential to redefine the assessment of behaviours which influence health, they are not routinely used in clinical practice.

Objective: Establish consensus on how wearable technology can be applied to support clinical care for people aged 50 and over experiencing changes to mobility and/or who are at increased risk of falling.

Methods: A Delphi study was conducted among 17 hospital-based health professionals. Over three rounds, experts were asked about fall prevention, mobility assessment, the potential role of wearable sensors, and clinical considerations for implementing wearable technology into practice. Consensus was defined as 75% agreement. Data were analysed using qualitative and quantitative methods.

Results: Experts found that wearable technology has short and long-term clinical utility, data should be shared with general practitioners to improve long-term health outcomes, and devices would need to fit all individuals with a preference for wrist or pendant-worn locations. Technological literacy was not a perceived barrier. However, cost and data accuracy were important for successful implementation.

Conclusion: This study provides a group consensus statement and guidance on the clinical implementation of wearable technology to support care for people aged 50 and over experiencing changes to mobility and/or who are at increased risk of falling. Health professionals are receptive to using wearable technologies to advance fall risk and mobility assessment and believe wearable technology has a role in clinical practice.

Background and purpose: A preventative model of physical therapy (PT) care to promote activity and minimize mobility loss with aging is not routine. Performance testing and patient education are recommended to increase the perceived value of results to inform health decision-making. This study evaluated (1) the Single Leg Stance (SLS) test for an annual visit based on a priori criteria and (2) the effect of education on the perceived value of SLS and walking speed test results as health indicators.

Methods: In a cross-sectional study, ambulatory adults aged 55+ completed a pre-survey, performed SLS and walking speed tests, received education about their results, and completed a post-survey. The distribution of test results was displayed with histograms and analyzed for correlations. Participants used a Likert scale to rate how they perceived the value of their test results as health indicators before and after education and their satisfaction with the education received, including a novel pocket card.

Results: On average, participants (n = 152) were 64 years old (age range 55-82), 91% white, and 61% female. Walking speed results were normally distributed, and SLS results demonstrated a ceiling effect. Participants were below published norms for SLS 33% of the time and 34% for walking speed. The SLS test took an average of 3.6 minutes to complete. Binarized results for the tests as at/above and below norms were correlated with χ2 (1, N = 152) = 10.48, P = .001. The test results were significantly more valued as health indicators after education. Seventy-two percent of participants agreed (median rating 4, range 1-5) that they would be interested in PT if their walking speed results were below the norm, and 76% agreed for SLS.

Conclusion: The ceiling effect disadvantages the SLS test with an annual PT visit. Education on test results and comparison to norms increased how older adults valued physical performance measures as health indicators.

Background and purpose: Motivational interviewing, an evidence-based person-centered counseling style, may help to facilitate increased mobility and physical activity after hip fracture. We explored contextual factors influencing the outcome, mechanism, and implementation of motivational interviewing after hip fracture.

Methods: A qualitative study was completed using an interpretive description framework. Data sources included verbatim transcriptions of interviews with purposively sampled patients (n = 18), clinicians (n = 6 including 3 physical therapists), and relevant physical therapy stakeholders (a trial coordinator, a manager, and physical therapists involved in trial recruitment; n = 4), and 128 randomly selected clinician diaries where clinicians recorded notes at the end of each motivational interviewing session. Data were independently coded by 2 researchers and mapped to the Medical Research Council process evaluation framework. Consensus discussions involving all researchers were completed to triangulate the data and develop an interpretive synthesis.

Results: We found 3 main themes and 3 subthemes in the data. The main themes were: (a) It's about life, (b) Walking is not the goal, and (c) It's complicated. The last theme was further developed into a model depicting internal, external, and social factors influencing the outcome, mechanism, and implementation of motivational interviewing after hip fracture. Internal factors related to physical and psychological functioning. External factors included elements related to the environment and health services. Social factors included having a support system, receiving positive feedback, isolation, and feeling overwhelmed. Factors interplayed to create a multitiered model, with the person's life at the center. Traditional rehabilitation was perceived as addressing the physical factors of hip fracture, while motivational interviewing intervention was considered to address the whole person.

Conclusion: Many contextual factors interplay to influence motivational interviewing intervention after hip fracture. For successful hip fracture rehabilitation, our results suggest physical therapists and other care providers address these factors in addition to physical rehabilitation and focus on the person at the center of the process.

Background and purpose: Targeted interventions to maintain physical performance in older adults are important. We aimed to validate an existing 4-item prediction model and, if necessary, develop a new model for early identification of adults aged 65+ with persistent reduced physical performance.

Methods: A temporal validation study on adults aged 65+ admitted to the emergency department for medical reasons and who performed ≤8 repetitions in the 30-second chair-stand test (30s-CST) within the first 48 hours of admission. The primary outcome was the number of 30s-CST repetitions (≤8 or >8) performed at the older adults' homes 3 to 4 weeks after admission.

Physical performance and self-reported data were analyzed using univariate and multivariate logistic regressions. The optimal model was chosen based on the area under the curve.

Results and discussion: The validation of a previously developed 4-item prediction model indicated that the model did not consistently apply to other populations of older adults. To develop a new model aimed at identifying acutely hospitalized older adults with persistent reduced physical performance, we combined 2 samples comprising 132 older adults with a 30s-CST score > 8 and 250 adults with a 30s-CST score ≤ 8 when measured 3 to 4 weeks after admission. The new model included 5 variables: age >80, female, self-reported difficulties in climbing a flight of stairs, less good/poor self-rated health, and a 30s-CST score ≤ 5. The model had an area under the curve of 84%. The model is expected to improve the identification of older adults with persistent reduced physical performance compared to health professionals' subjective assessments and/or adults' self-reported information.

Conclusions: The initial 4-item prediction did not consistently apply to other populations of older adults. Consequently, 2 samples were combined and a 5-item model was developed. Since the model involves only 5 items, it is easy to implement and provides health professionals an opportunity for targeted intervention on older adults during and after acute hospitalization. A validation study for the 5-item model is necessary.