Journal of Geriatric Physical Therapy最新文献

Purpose: Geriatric physical therapy (PT) has evolved since 2011, when the Essential Competencies (ECs) in the Care of Older Adults at the Completion of the Entry-level Physical Therapy Professional Program of Study were published. The purpose of the ECs was to ensure that all entry-level physical therapists were prepared to meet the unique needs of the growing older adult population. Changes in population demographics, medical and research advances, coupled with advancements in the profession of PT, necessitate a revision of the ECs.

Process: The Academic Education Committee of APTA Geriatrics was convened to revise the original ECs. Participation was solicited and obtained from experts in clinical and academic geriatric PT; committee work lasted from 2021 to 2024. The committee recognized the intersection of the Domains of Competence Framework developed by the American Physical Therapy Association (APTA), American Council of Academic Physical Therapy, and the Academy of Education partnership, the geriatric medicine 5Ms model, and the Commission on Accreditation in Physical Therapy Education (CAPTE) standards in guiding entry-level PT education. The committee determined that the Domains of Competence, Geriatric 5Ms, and CAPTE standards could synergistically enhance the establishment of contemporary ECs. Input from a nonresearch-based informational survey of APTA Geriatrics members, supported by feedback from discussion at a platform presentation at the APTA's Combined Section Meeting San Diego 2023, informed the revised ECs presented in the current manuscript.

Outcome: This manuscript presents the revised ECs and describes how each EC links to the Domains of Competence, the Geriatric 5Ms, and CAPTE standards. The updated ECs aim to promote best practices in entry-level PT education by providing all stakeholders clear and concise competency statements for the physical therapy examination and treatment of older adults.

The Geriatric 5Ms framework offers a comprehensive, person-centered approach to addressing the complex needs of older adults. Initially developed in geriatric medicine, the 4Ms strategy- Medications, Mind, Mobility , and what Matters Most to the patient-challenges clinicians to consider these dimensions in guiding care decisions. The Geriatric 5Ms builds on this framework and adds Multicomplexity , which emphasizes the management of multiple co-existing acute and chronic conditions, along with social and environmental factors and access to resources. The Geriatric Movement System Task Force recognizes the relevance of the 5Ms framework for addressing the functional movement needs of older adults with complex medical conditions. As movement experts, physical therapists are uniquely positioned to assess, monitor, and address Mobility issues while considering the impact of Medications, Mind, and Multicomplexity on movement and function. Engaging in meaningful conversations with older adults and their families about what Matters Most further ensures that care aligns with the individual's values and goals, forming the groundwork for successful outcomes. This article highlights the significance of the Geriatric 5Ms framework and advocates for its integration into physical therapy practice. By adopting this model, physical therapists can enhance examination, intervention planning, and rehabilitation outcomes, ultimately optimizing care for older adults.

Background and purpose: Patients with end-stage hip osteoarthritis typically elect total hip arthroplasty (THA) to improve life activity performance while clinical outcomes focus on physical capacity. However, it is unclear how improvements in life activity performance relate to improvements in physical capacity following THA. This study aimed to assess the longitudinal relationship between improvement in life activity performance (ie, decreases in sedentary time) and improvements in physical capacity (ie, increases in 6-Minute Walk [6MWT] distance) from before THA to a 6-month post-THA follow-up time point.

Methods: This is a secondary analysis of a double-blind randomized controlled trial that enrolled individuals 50 to 85 years of age with unilateral hip osteoarthritis who underwent THA. Longitudinal variables of interest included the % of active wear time in sedentary activity using a hip-mounted wearable accelerometer-based monitor [ActiGraph wGT3X-BT] and 6MWT distance. The variables were modeled to extract predicted change scores, and simulations were used to determine if each participant had a change in sedentary time and 6MWT distance. Participants were classified on whether they improved sedentary activity time (P+: decrease in sedentary time or P-: no improvement in sedentary time) and/or 6MWT distance (C+: increased 6MWT distance or C-: no improvement in 6MWT distance). Independent sample t-tests (continuous variables) and Fisher exact tests (categorical variables) were used to compare characteristics between classification groups.

Results and discussion: All 76 participants (age: 63.9 ± 7.0 years, 64.5% male) were classified as C+, as all improved physical capacity. A majority (n = 45; 59.2%) were C+/P+, while 31 participants (40.8%) were classified as C+/ P-, and no participants were classified as C-/P+ or C-/ P-.

Conclusions: There is a noted disagreement between improvements in life activity performance versus physical capacity suggesting gains in the 6MWT are not always associated with reductions in sedentary time during recovery from THA. Improving physical capacity does not equate to decreased sedentary time. Thus, different rehabilitation targets (ie, behavior change interventions) may need to be identified and explored to enhance life activity performance following THA that may better align with patient performance goals.

Background and purpose: Physiotherapists in nursing homes perform a diversity of roles and tasks. But the delivery of physiotherapy services varies widely between organizations and between individual physiotherapists. This depends on both organizational and personal factors. This study aims to investigate to what extent physiotherapists in Dutch nursing homes agree on the scope and content of their professional roles and tasks.

Methods: We performed a cross-sectional survey study of a convenience sample of physiotherapists in nursing homes. The questions were divided into five themes: (1) care and functional problems (falls, incontinence, physical strain, decubitus, inactivity/immobility, pain, problems with lying and sitting, the use of physical restraints, malnutrition and sarcopenia, overweight, behavioral problems, oedema, joint contractures), (2) referrals and accessibility, (3) assessments and examinations, (4) interventions and actions, and (5) organizational matters. We asked the participants to answer the questions on a five-point Likert scale. We defined consensus when ≥75% of the participants rated the question with a Likert-score of 4 or 5 or with a Likert-score of 1 or 2.

Results and discussion: Sixty-five physiotherapists returned the survey. They agreed that physiotherapists play an essential role in the management of prevention of falls, mobility problems, transfer problems, ergonomic advice, physical strain, pain, problems with sitting and lying, sarcopenia, and joint contractures. There was a discrepancy in consensus regarding what a physiotherapist should do in the specific cases versus what they actually do.

Conclusion: Physiotherapists in nursing homes agreed they have an important role in a variety of care and functional problems. However, there was a difference between what needs to be done versus what is actually done by the physiotherapists. Future research should focus on the underlying reasons for this inconsistency.

Background and purpose: Identifying preclinical mobility limitation (PCML) and mobility disability are critical for a preventative model of physical therapy. Subjective fall risk and mobility screening questions are used to determine the need for objective testing. This study aimed to determine the diagnostic accuracy of subjective screening for mobility impairment.

Methods: Participants answered 8 evidence-based subjective fall risk and mobility screening questions followed by evaluation with the Short Physical Performance Battery (SPPB) and the grip strength test. Gait speed and the Five Times Sit to Stand Test time were calculated from the SPPB. Reference standards for the tests were used to binarize results as at/above or below standards. Relationships between binarized subjective screening and objective test results were analyzed with Phi (φ) correlation coefficients. Sensitivity and specificity were calculated for relationships with acceptable cutoff values ( P < .05, φ  > 0.3). Binomial regression was used to determine the sensitivity and specificity of asking multiple questions. Screening questions were considered useful predictors of the objective test result if combined sensitivity and specificity were ≥1.5.

Results and discussion: Ambulatory adults (N = 83) aged 65 to 92 years ( M = 70) participated. One question-"Do you have difficulty with balance?"-met the diagnostic accuracy threshold for predicting the SPPB outcome with a sensitivity of 0.632 and a specificity of 0.871.

Conclusions: Subjective screening does not adequately predict objective test results for identifying PCML. The findings indicate that improved screening tools or more referrals for objective testing are needed to detect early mobility loss with aging.

Background and purpose: Frailty, a multidimensional syndrome, is linked with heightened risk of adverse outcomes. Targeted physical therapy interventions for individuals with frailty have proven beneficial, underscoring the value of routine frailty assessment in both clinical and research settings. This study aimed to: (1) describe development of a simple self-report cumulative deficits frailty scale (Sr-CDFS); (2) establish the criterion validity of Sr-CDFS against the commonly used Fried's frailty scale and Study of Osteoporotic Fracture criteria (SOF); and (3) assess other concurrent validity and internal consistency of the new Sr-CDFS.

Methods: The study included 230 older adults (M age = 79.27 ± 7.42 years), with 76.5% being women. Outcome measures were: (1) validated frailty scales, including Fried's frailty phenotype, SOF, and Sr-CDFS; and (2) a battery of tests for impairment, activity limitations, and health status. Data analysis involved calculating frailty prevalence using the validated frailty scales. The clinimetric properties of the Sr-CDFS were assessed against validated frailty scales. Convergent and discriminative validity of the Sr-CDFS were examined. Internal consistency and structure were evaluated using Cronbach's alpha and exploratory factor analysis.

Results and discussion: No differences (P = .80) in frailty prevalence were found between Fried (26.1%) and SOF (25.2%) methods. The Sr-CDFS exhibited excellent internal consistency (Cronbach's alpha = .92), with reliability of questionnaire components (health, falls, physical, cognitive, socioemotional function) ranging from .73 (falls) to .90 (physical ability). Additionally, the Sr-CDFS demonstrated convergent and discriminative validity, with its total score and various parts correlating significantly with most outcomes (r = .25-.59, P < .05). Using K1-criterion and a scree plot, we identified a 5-factor solution that had a common variance of 63.9%.

Conclusion: The newly developed Sr-CDFS exhibits robust clinimetric properties with good-to-excellent reliability and validity. The newly developed Sr-CDFS has the potential to increase the feasibility of assessing frailty in clinical settings or large-scale epidemiological studies.

Background and purpose: An adapted version of the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention initiative was implemented for older adults ≥ 65 years of age attending 34 outpatient physical therapy clinics in a large state-wide health system.

Methods: We explored physical therapists' (PTs) use and perceived determinants of implementation of an adapted version of STEADI using an explanatory mixed-methods approach (n = 50 surveys, 13 interviews). We analyzed survey data using descriptive statistics and mapped interview data to Consolidated Framework for Implementation Research 2.0 constructs using rapid template analysis.

Results and discussion: Participants believed that falls were preventable, used STEADI > 50% of the time, and agreed that STEADI was suitable and implementable. The STEADI components with low reported complexity aligned with high use and are included in the original STEADI (>50%; assessing and intervening in foot problems/footwear, home safety, balance, strength, endurance, gait, activity modifications, and caregiver training). Components with high reported complexity aligned with lower use, and the majority are not included in the original STEADI (<50%; assessing medication, vestibular function, cognition, and pelvic health interventions). Implementation facilitators included compatibility, embedding components of STEADI (eg, questionnaire and functional assessment) in the workflow and electronic health record (EHR), and relational connections. Implementation barriers included perceived lack of capability to conduct specific STEADI components (eg, medication assessment and specific interventions), lack of the EHR workflow of assessment and intervention components, and desire for more clinical decision support in the EHR, implementation support, and ongoing training.

Conclusion: Physical therapists reported higher adoption rates and lower complexity to implement components original to STEADI or common in physical therapy practice compared to the adapted/additional components added by the health system. The study results can be used to develop and adapt strategies to support the implementation and dissemination of STEADI or adapted versions in other outpatient clinics and health systems.

APTA-Geriatrics, an Academy of the American Physical Therapy Association, appointed a guideline development group (GDG) to develop a clinical practice guideline (CPG) synthesizing the evidence for physical therapy management of fall risk in community-dwelling older adults. The GDG consisted of five physical therapists with clinical expertise in the management of fall risk in older adults and methodological expertise in evidence-based document development. The CPG includes a systematic review of existing literature, and stringent methodology developed by the American Physical Therapy Association to form the evidence-based recommendations. The CPG content, including methodology, recommendations and algorithm were externally reviewed by clinical providers and academicians with expertise in fall risk management for older adults. These recommendations are intended to assist physical therapists and physical therapist assistants who are engaged in fall risk management for community-dwelling older adults.