The First Physical Therapy Summit on Global Health: implications and recommendations for the 21st century.

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.

Lack of relationship between gait parameters and physical function in peripheral arterial disease.

OBJECTIVE: Physical function is limited in patients with peripheral arterial disease who are symptomatic with intermittent claudication (PAD-IC). When patients with PAD-IC experience claudication, previous reports have described gait abnormalities, including alterations in step length and cadence. This study tested the hypothesis that patients with PAD-IC would have a decrease in usual and maximal walking speed and that this alteration in gait parameters would contribute to their decreased physical function scores, even in the absence of claudication. The aims were to evaluate usual and maximal walking speed and gait parameters (step length, cadence and toe out angle) in subjects with PAD-IC and control subjects with similar baseline activity levels. METHOD: A cross-sectional study of 25 subjects with PAD-IC compared with 26 age-matched controls was conducted in a research laboratory in an academic medical center. Study subjects were similar in age, gender, and physical activity status. Subjects with PAD-IC had an ankle-brachial index <0.90 in at least one leg and reported symptoms of intermittent claudication that limited walking ability. Subjects in either group were excluded if they used assistive devices to walk or were limited in walking ability by orthopedic, neurologic, cardiac, or pulmonary symptoms. Gait parameters were assessed at the onset of walking (before the development of claudication pain in the PAD-IC group) at self-selected and maximal walking speeds during which step and stride characteristics were collected. Subjects completed a physical activity recall, a Short Form questionnaire (SF-36), and a 6-minute walk that was limited by claudication in the PAD-IC group. RESULTS: During gait testing, no patient with PAD-IC developed claudication. There were no significant differences between the PAD-IC and control groups in usual or maximal walking speed or other gait variables (step length, cadence, stride width, toe out angle). In contrast, the SF-36 physical function score was reduced 15.2 percentage points (P < .02) and the summary physical component score was reduced 6.7 percentage points in the PAD-IC group compared with controls (P = .002). In addition, the 6-minute walk distance was significantly less in the PAD-IC group than in the control group by 308.8 feet (P < .001). A series of bivariate analyses demonstrated that PAD-IC was the best predictor of reduced physical function, whereas no gait parameter was associated with reduced physical function. CONCLUSION: Patients with PAD-IC have significantly reduced 6-minute walk distance and reduced physical function by questionnaire scores that was not explained by any effects of PAD-IC on walking speed and selected gait parameters assessed before the onset of claudication pain.

Evaluation of physical therapists' knowledge, attitudes, and professional use of dietary supplements: implications for practice and education.

PURPOSE: The objective of this cross-sectional study was to better define physical therapists' (PTs) knowledge, attitudes, and professional reported use of dietary supplements (DSs). METHODS: This study was approved by University of Colorado Investigational Review Board. A survey was developed and piloted to evaluate knowledge of supplement indications and serious side effects; comfort in performing medication and supplement histories and making therapeutic recommendations; and current practice and attitudes of supplement use and resource information. Therapists were identified through the Colorado Board of Physical Therapy. Five hundred surveys were mailed. Analysis of the survey items consisted of descriptive statistics and qualitative analysis of free text for themes and concepts. RESULTS: One-hundred eighty-four surveys were returned (38% response rate). Eighty-two percent were female. Forty-nine percent had a baccalaureate degree, 38 % master's degree, and 1.6 % Doctor of Physical Therapy. Over 50% practiced in an ambulatory setting. While 46% believed they were adequately educated on DS, only 50% of respondents could identify the correct indication for the designated supplement, while less than 6% one correct serious side effect, once efedra was excluded. For supplement information, more than 90% turned to non-peered review materials. Forty percent of therapist indicated that they were currently recommending DSs to their patients. Glucosamine, glucosamine with chondroitin, and methyl-sulfonylmethane comprised the top supplements suggested. CONCLUSIONS: PTs are recommending DS within their practice. While many therapists noted they were adequately educated, gaps in knowledge base were apparent. As physical therapy curricula continue to evolve, the addition of DS instruction should be considered a priority, as well as, steps put in place to provide additional education for practicing therapists.

Cardiovascular assessment in the orthopaedic practice setting.

As consumer access to physical therapy practice expands, it is important that physical therapists are familiar with and implementing accepted methods of identifying the cardiovascular status of their clients. Established guidelines for assessing cardiovascular risk prior to initiating aerobic exercise programs are available and can be readily adopted by physical therapists in diverse clinical settings. We have provided a process for integrating existing guidelines into clinical practice. Because little evidence exists regarding the clinical behaviors and knowledge of orthopedic physical therapists in the area of cardiovascular risk, we conducted a survey to assess current practice patterns. The results suggest that orthopedic physical therapists are performing cardiovascular screening at frequencies similar to other components of the history and systems review, but that monitoring baseline or exercising vital signs does not occur with every exercise session.