ABSTRACT
BACKGROUND: Falls in older adults are a major public health concern due to high prevalence, impact on health outcomes and quality of life, and treatment costs. Physical therapists can play a major role in reducing fall risk for older adults; however, existing clinical practice guidelines (CPGs) related to fall prevention and management are not targeted to physical therapists. OBJECTIVE: The purpose of this clinical guidance statement (CGS) is to provide recommendations to physical therapists to help improve outcomes in the identification and management of fall risk in community-dwelling older adults. DESIGN AND METHODS: The Subcommittee on Evidence-Based Documents of the Practice Committee of the Academy of Geriatric Physical Therapy developed this CGS. Existing CPGs were identified by systematic search and critically appraised using the Appraisal of Guidelines, Research, and Evaluation in Europe II (AGREE II) tool. Through this process, 3 CPGs were recommended for inclusion in the CGS and were synthesized and summarized. RESULTS: Screening recommendations include asking all older adults in contact with a health care provider whether they have fallen in the previous year or have concerns about balance or walking. Follow-up should include screening for balance and mobility impairments. Older adults who screen positive should have a targeted multifactorial assessment and targeted intervention. The components of this assessment and intervention are reviewed in this CGS, and barriers and issues related to implementation are discussed. LIMITATIONS: A gap analysis supports the need for the development of a physical therapy-specific CPG to provide more precise recommendations for screening and assessment measures, exercise parameters, and delivery models. CONCLUSION: This CGS provides recommendations to assist physical therapists in the identification and management of fall risk in older community-dwelling adults.
Subject(s)
Accidental Falls/prevention & control , Independent Living , Mass Screening , Physical Therapy Specialty/methods , Aged , Humans , Postural Balance/physiology , Risk Assessment , Walking/physiologySubject(s)
Consensus Development Conferences as Topic , Evidence-Based Practice , Geriatrics , Physical Therapy Specialty , Professional Autonomy , Societies , Clinical Competence , Geriatrics/education , Geriatrics/standards , Health Services for the Aged , Humans , Nervous System Diseases , Organizational Objectives , Outcome and Process Assessment, Health Care , Physical Therapy Specialty/education , Physical Therapy Specialty/organization & administration , Physical Therapy Specialty/standards , Planning Techniques , Professional-Patient Relations , United StatesABSTRACT
The answer to the question, "Is autonomous practice in neurologic physical therapy defined differently based on the type of practice setting?" is no. Autonomous practice is a characteristic of the physical therapist, embodying excellence, communication and collaboration, and advocacy and caring. It is our belief that many physical therapists already practice autonomously, even though they may not recognize their practice as being autonomous; and it is our hope that physical therapists who are functioning as autonomous practitioners will provide peer mentoring to help bring their colleagues to the same level of practice and the same recognition. The full position statement on autonomous practice is available on the Neurology Section Web site at http://www.neuropt.org/go/healthcareprofessionals/autonomous-practice.
Subject(s)
Nervous System Diseases/rehabilitation , Physical Therapy Specialty/standards , Physical Therapy Specialty/trends , Private Practice/standards , Private Practice/trends , Humans , Professional Autonomy , Quality of Health CareABSTRACT
PURPOSE: To develop a measure of 3 social cognitive theory constructs (self-efficacy expectations, outcome expectations, and outcome expectancies) for predicting home exercise program (HEP) adherence in older adults after discharge from home health physical therapy. METHODS: A questionnaire was developed, pilot-tested, and administered to 50 participants (mean age 79.9 years, range 65-91 years) who were being discharged from home health physical therapy on a HEP. Participants also completed the 12-item Short-form Health Survey (SF-12), Mini Mental State Examination, and short form of the Geriatric Depression Scale. Participants reported level of adherence to the HEP at 1 month. RESULTS: There was a strong positive response bias for all 42 items comprising the questionnaire. Two constructs (self-efficacy expectations and outcome expectations) demonstrated test-retest reliability, while the third (outcome expectancies) did not. There was no association between any of the 3 constructs and the 2 scales of the SF-12. Participants' scores on the questionnaire did not predict HEP adherence. CONCLUSION: While previous studies have shown that questionnaires based on social cognitive theory constructs predict exercise adherence in community-dwelling older adults, the current study did not establish this relationship in older adults after discharge from home health physical therapy. Future research should address scaling issues.
