Teaching for Practice: The Impact of a Large-Scale Interprofessional Foundational Program.

PURPOSE: The University of Kansas Medical Center has developed an interprofessional education (IPE) foundational program using TeamSTEPPS, a curriculum designed to improve patient care through effective communication and teamwork. The purpose of this study was to understand the impact of the Level 1 program on learners as they develop the attitudes, knowledge, and skills related to interprofessional collaborative practice. METHODS: Learners (n=715) representing 15 professions participated in the Level 1 program. A mixed-methods approach was used to assess achievement of learning objectives, learner reactions, modifications of perceptions and attitudes, acquisition of knowledge and skills, and anticipated behaviors. RESULTS: Learners (n=585, 81.8%) agreed that the program was valuable. Positive changes in attitudes were significant pre-post (p<0.001). An average of 80.3% of learners who responded (n=196, 27.4%) correctly answered knowledge survey questions. Furthermore, analysis of open-ended questions suggested that learners gained an increased appreciation for interprofessional communication and better understanding of the roles of other healthcare professions. CONCLUSIONS: Based on positive learner reactions, changes in attitudes and knowledge, and anticipated behaviors associated with this program, similar approaches that incorporate TeamSTEPPS early in professional curricula may be useful for foundational IPE programming due to the intentional alignment with collaborative practice and orientation towards the Quadruple Aim.

Adults with diabetic peripheral neuropathy exhibit impairments in multitasking and other executive functions.

BACKGROUND AND PURPOSE: Diabetic peripheral neuropathy (DPN) contributes to functional impairment, and there is growing evidence that neuropsychological factors also influence physical function. We compared cognitive and executive function in adults with DPN with an age-matched comparison group, and examined the relationships between DPN, executive function, and physical function. METHODS: Twenty subjects with DPN and 20 comparison subjects were assessed. Diabetic peripheral neuropathy was quantified via the Michigan Neuropathy Screening Instrument and nerve conduction velocity testing. Subjects were administered Beck's Depression Inventory, the Mini-Mental Status Examination, and the Timed Up and Go (TUG) test. Each participant also completed a battery of 7 executive function tasks, including the Cognitive Timed Up and Go (cTUG) test, in which a concurrent mental subtraction task was added to the standard TUG test. RESULTS: The DPN group demonstrated poorer letter fluency (34.2 ± 11.6 words vs 46.2 ± 12.2 words; P = 0.001), category fluency (47.0 ± 8.1 words vs 56.3 ± 8.5 words; P = 0.003), and Rey-Osterrieth scores (25.9 ± 4.3 points vs 31.7 ± 2.4 points; P < 0.001), and took longer to complete both the TUG (10.3 ± 2.8 seconds vs 5.9 ± 1.0 seconds; P < 0.001) and cTUG (13.0 ± 5.8 seconds vs 6.9 ± 1.6 seconds; P < 0.001). Poorer global cognitive performance and greater depression symptoms were significantly related to each other (r = -0.46; P = 0.04) and to slower TUG times (r = -0.53; P = 0.02; and r = 0.54; P = 0.02, respectively). DISCUSSION AND CONCLUSIONS: Verbal, visuospatial, and multitasking measures of executive function may be impaired in adults with DPN. Future research should examine how these and other cognitive and psychological factors, such as depression, affect physical function in this population.

Diagnostic accuracy of fall risk assessment tools in people with diabetic peripheral neuropathy.

BACKGROUND: Diabetic peripheral neuropathy affects nearly half of individuals with diabetes and leads to increased fall risk. Evidence addressing fall risk assessment for these individuals is lacking. OBJECTIVE: The purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent "fallers" and those who are not recurrent fallers. DESIGN: A cross-sectional study was conducted. SETTING: The study was conducted in a medical research university setting. PARTICIPANTS: The participants were a convenience sample of 36 individuals between 40 and 65 years of age with diabetic peripheral neuropathy. MEASUREMENTS: Fall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, the Timed "Up & Go" Test, the Berg Balance Scale, and the Dynamic Gait Index. Sensitivity, specificity, positive and negative likelihood ratios, and overall diagnostic accuracy were calculated for each fall risk assessment tool. Receiver operating characteristic curves were used to estimate modified cutoff scores for each fall risk assessment tool; indexes then were recalculated. RESULTS: Ten of the 36 participants were classified as recurrent fallers. When traditional cutoff scores were used, the Dynamic Gait Index and Functional Reach Test demonstrated the highest sensitivity at only 30%; the Dynamic Gait Index also demonstrated the highest overall diagnostic accuracy. When modified cutoff scores were used, all tools demonstrated improved sensitivity (80% or 90%). Overall diagnostic accuracy improved for all tests except the Functional Reach Test; the Timed "Up & Go" Test demonstrated the highest diagnostic accuracy at 88.9%. LIMITATIONS: The small sample size and retrospective fall history assessment were limitations of the study. CONCLUSIONS: Modified cutoff scores improved diagnostic accuracy for 3 of 4 fall risk assessment tools when testing people with diabetic peripheral neuropathy.

Effects of age and localized muscle fatigue on ankle plantar flexor torque development.

BACKGROUND AND PURPOSE: Older adults often experience age-related declines in strength, which contribute to fall risk. Such age-related levels of fall risk may be compounded by further declines in strength caused by acute muscle fatigue. Both age- and fatigue-related strength reductions likely impact the ability to quickly develop joint torques needed to arrest falls. Therefore, the purpose of this study was to investigate the combined effects of age and localized muscle fatigue on lower extremity joint torque development. METHODS: Young (mean age, 26 (2.5) years) and older (mean age, 71 (2.8) years) healthy male adults performed an isometric ankle plantar flexion force control task before and after an ankle plantar flexor fatiguing exercise. Force control performance was quantified using onset time, settling time, and rate of torque development. RESULTS: Age-related increases and decreases were observed for onset time and rate of torque development, respectively. A fatigue-related decrease in rate of torque development was observed in young, but not older adults. DISCUSSION: The results suggest performance declines that may relate to older adults' reduced ability to prevent falls. A fatigue-related performance decline was observed among young adults, but not older, suggesting the presence of age-related factors such as motor unit remodeling and alterations in perceived exertion. CONCLUSIONS: Older adults demonstrated an overall reduction in the ability to quickly produce ankle torque, which may have implications for balance recovery and fall risk among older adults.