APTA Geriatrics' Guiding Principles for Best Practices in Geriatric Physical Therapy: An Executive Summary.

Geriatric physical therapy requires a unique skill set and knowledge to provide best practice care. The skill set requires clinicians to recognize the significance of the continuum of aging from optimal to pathology-influenced aging and how psychosocial, environmental, behavioral, accessibility, and economic factors affect this aging continuum, optimal health, and wellness. Employing this distinctive skill set while also utilizing evidence-based practice, acknowledging the variability observed in older adults, and utilizing interwoven care systems that impact outcomes are key characteristics of best practice. The Academy of Geriatric Physical Therapy developed best practice guidelines consisting of 6 principles needed to ensure patients receive the care that they deserve. Best practice principles include person-centered care, anti-ageist beliefs, holistic assessment using sound outcome measures, evidence-based interventions, physical activity promotion, and interprofessional collaborative practice. This executive summary presents these principles along with suggested action steps for each element of best practice. The aims are to encourage individual self-assessment, promote improvement in practice on an individual and facility/system level, increase communication and collaboration with other health care providers about global best practices for older adults, and to further target education, resources, and advocacy toward achieving best practice on a larger scale.

Performance and Clinimetric Properties of the Timed Up From Floor Test Completed by Apparently Healthy Community-Dwelling Older Women.

BACKGROUND AND PURPOSE: Standing up from the floor is a demanding mobility activity with important implications. The purpose of this study was to describe performance and the clinimetric properties of the Timed Up From Floor (TUFF) test completed by apparently healthy community-dwelling older women. METHODS: In this observational and methodological quality study, 52 community-dwelling women, 55 years and older, were examined. Convergent and discriminant validities were examined by analyzing the correlations of TUFF test times with other mobility variables and emotional status, respectively. Validity was further examined by comparing TUFF times between age groups and fall risk groups. Interrater reliability of the TUFF test was established by comparing the times obtained by 3 raters observing the same videotaped performances. Test-retest reliability was determined by having the same 3 raters observe videos of the same participants performing the TUFF test during a second session 1 week later. RESULTS: The grand mean (SD) TUFF time measured by all testers on the first day was 5.8 (2.9) seconds. Convergent validity was demonstrated by significant negative (P < .001) Spearman correlations between the TUFF test and the Physical Functioning Scale of the 36-Item Short Form Health Survey (SF-36) (-0.69), usual gait speed (-0.48), fast gait speed (-0.74), and the 30-second sit-to-stand test (-0.46). Discriminant validity was indicated by a low and nonsignificant correlation (0.17) between the TUFF test and the SF-36 Emotional Well-being Scale. Known-groups validity was supported by a significant difference in the TUFF test times of 2 age groups (P = .02) and 2 fall risk groups (P < .001). The TUFF test was determined to have excellent relative interrater reliability (intraclass correlation coefficient [ICC] of 0.99) and absolute reliability (minimal detectable change [MDC95%] of 0.8 seconds). Relative test-retest reliability was excellent with ICCs of 0.88 to 0.92. Corresponding MDC95% values were large (2.4-2.8 seconds and 40.7%-45.9%). CONCLUSIONS: The TUFF test is an informative, reliable, and valid tool suitable for documenting mobility limitations in independent community-dwelling older women. More information regarding responsiveness is required.

A Movement system impairment approach to evaluation and treatment of a person with lumbar radiculopathy: A case report.

BACKGROUND AND PURPOSE: There are several systems of classification and treatment of patients with low back pain (LBP) based on assessment of the effect of lumbar postures and movements on symptoms. The efficacy of one of these systems, The Movement System Impairment (MSI) method, has not yet been demonstrated in the literature. The purpose of this case report is to describe the approach of the MSI method for an individual with lumbar radiculopathy. CASE DESCRIPTION: A 79-year-old woman with a history of chronic LBP was referred to PT with a physician's diagnosis of sciatica. The patient was classified utilizing a standardized MSI evaluation. She was instructed to modify her daily postures and movements, as well as perform specific exercises to address these impairments. OUTCOMES: Her Oswestry LBP disability score improved by over 30% and pain level per the NPRS improved by 3 out of 10 points. DISCUSSION: Despite the challenges of advanced joint degeneration and neurological involvement, this approach of identifying and addressing specific movement impairments appeared helpful for this older individual.

Resilience, physical performance measures, and self-perceived physical and mental health in older Catholic nuns.

BACKGROUND AND PURPOSE: The importance of physical performance measures and their influence on predicting future disability has been suggested; however, the association between resilience and physical performance measures in older women needs further study. The purpose of this research study was to investigate the resilience level in a convenience sample of older women who happened to be Roman Catholic nuns. The relationships of resilience with specific physical performance measures, self-perceived physical and mental health status, and depressive symptoms were also explored. METHODS: Descriptive correlational cross-sectional design was used. Data from 54 volunteer Roman Catholic nuns, aged 55-94 were collected beginning with self report questionnaires followed by physical performance tests. Self-report measures included the Resilience Scale, Short-Form revised (SF-12v2) Health Survey, and Patient Health Questionnaire (PHQ-9). The 12-point Short Physical Performance Battery (SPPB) and fast gait speed were the physical performance tests measured. RESULTS: This sample of nuns had moderate levels of resilience. Those with fewer depressive symptoms and better health had higher resilience levels. Fast gait speed was positively associated with resilience. DISCUSSION: The positive relationship between resilience and gait speed is an important finding of this study because it reinforces the connection between physical and emotional health. Future studies should examine if resilience and gait speed can serve as predictors of disability in a broader sample of older adults or if resilience can be targeted as a means of improving physical performance. CONCLUSION: Maintaining functional ability and recovering when physical injury is experienced is of great importance in older adults. It is reasonable for physical therapists to consider both resilience and physical performance measures when attempting to identify older women at risk for poor outcomes. Resilience may play a role in helping older adults recover from a physical injury.

Case report: an evidence-based approach to examination and intervention following hip fracture.

BACKGROUND AND PURPOSE: A majority of older adults with hip fracture retain longstanding disabilities following surgery. Research suggests that more aggressive treatment techniques can improve outcome. The purpose of this case report is to describe an evidence-based approach to guide physical therapy examination and intervention for a woman with significant frailty recovering from hip fracture. CASE DESCRIPTION: The patient is a 97-year-old woman residing in a skilled nursing facility 3 months status-postsurgical repair of an intertrochanteric hip fracture. She had received 2 1/2 months of physical therapy care using conventional interventions, however, had not regained her prefracture mobility status. She agreed to participate in a progressive high-intensity resistance training program over a 2-month period to augment her lower-extremity strength and function. The 5-day training regimen emphasized resistance training with a weighted belt twice-weekly with endurance and balance training interposed on nonstrength training days. The patient's goal was to return to community dwelling. EXAMINATION: Lower-extremity isometric force was measured using handheld dynamometry. Functional mobility was assessed via Timed Up and Go, Six-Minute Walk, Berg Balance, and gait speed tests. A 9-item Physical Performance Test gauged degree of frailty. RESULTS: Hip extension, hip abduction, and knee extension isometric force scores on the involved lower-extremity increased by 8 kg, 3 kg, and 7 kg, respectively. Balance, frailty, and gait speed indices improved from 14 to 45, 8 to 18, and 0.50 to 0.83 m/s, respectively. CONCLUSION: Prescribed high-intensity resistance training was used to improve the patient's functional status 2 months after completing a conventional physical therapy program.

White paper: Strength training for the older adult.

The aim of this White Paper was to review the current recommendations for strength training of older adults, to promote physical therapist best practice and achieve optimal functional outcomes. A secondary intent was to encourage prospective researchers to use published guidelines to establish an adequate strength stimulus for patients in their research, rather than perpetuating "usual or traditional" care.