Background: An analysis of practice is conducted by the American Board of Physical Therapy Specia... more Background: An analysis of practice is conducted by the American Board of Physical Therapy Specialties (ABPTS) every 10 years to revalidate, update, and revise the description of specialty practice (DSP) for each specialty. The Geriatric Specialty Council recently conducted an analysis of practice and revised its content consistent with established procedures by the ABPTS. Purpose: The purpose of this article is threefold: first, to describe the process of the most recent practice analysis; second, to report revisions to the description of specialty practice based on the analysis of practice; and third, to identify elements of practice that define current specialist practice in geriatric physical therapy. Methods: A 10-member committee of subject matter experts (SMEs) and a psychometric consultant developed a survey instrument addressing geriatric physical therapy specialty practice areas. The survey was initially pilot-tested and subsequently administered online to a sample of 801 ...
This paper describes physical therapy programs to assist physical therapists in the rehabilitatio... more This paper describes physical therapy programs to assist physical therapists in the rehabilitation of patients with familial dysautonomia. There have been no reports in the literature about a physical therapy program for patients with this disease. A retrospective analysis of the clinical manifestations in 80 patients in a dysautonomia clinic was performed. Scoliosis and kyphosis were found in 92 percent of the patients, 93 percent had ataxia, 74 percent had feeding difficulties, 69 percent had frequent pneumonias, and 63 percent exhibited delayed developmental milestones. Cardiovascular, gastrointestinal, pulmonary, musculoskeletal, and neurological symptoms and treatments are discussed.
Background: To determine if a patented new computer controlled, pressure modulated knee rehabilit... more Background: To determine if a patented new computer controlled, pressure modulated knee rehabilitation machine was more effective, in rehabilitation of total knee arthroplasty, than the continuous passive motion machine utilizing Cochrane Review data. Methods: Prospective study of 197 patients: 59 outpatient rehabilitation facilities; 155 homebased care, and 7 skilled nursing facilities. Patients were prospectively treated with pressure modulated knee rehabilitation and standard rehabilitation for total knee arthroplasty. Range of motion (RoM) was compared (via ANOVA) with the Cochrane continuous passive motion study. We also evaluated RoM outcomes versus start day of pressure modulated knee rehabilitation use. Findings: Pressure modulated knee rehabilitation patient's ROM, at 30 days, exceeded 116°; significantly greater than all shortterm (6 weeks) Cochrane Review studies (83°). Patients using the pressure modulated knee rehabilitation six or more days after surgery had a significantly lower 14-day RoM than patients who began on days 1-5 following surgery. Interpretation: The pressure modulated knee rehabilitation patients increase their RoM following total knee arthroplasty significantly more than continuous passive motion users.
To compare the effects of epidural anesthesia and general anesthesia on early postoperative outco... more To compare the effects of epidural anesthesia and general anesthesia on early postoperative outcomes after unilateral primary total knee replacement, 262 patients were randomly assigned to receive either epidural or general anesthesia. All patients received a common rehabilitation protocol including a standardized assessment of progress. One hundred eightyeight patients received a common thromboembolic prophylaxis protocol with postoperative aspirin, and had a standardized surveillance protocol to detect thromboembolic complications. Deep vein thrombosis was determined by venography on the operative limb, and pulmonary embolism was determined by comparison of preoperative and postoperative lung perfusion scans. The epidural anesthesia
To describe a functional milestone scale (FMS) for measuring functional progression following tot... more To describe a functional milestone scale (FMS) for measuring functional progression following total hip arthroplasty and to demonstrate that this scale meets accepted standards of scale construction. Inter-observer reliability of the scale was determined for 30 patients using a kappa coefficient of concordance (k) for ordinal data, representing 221 pairs of observations. There were 79, 54, 44, and 44 pairs of observations for transfer, walker, crutch, and stair ambulation, respectively. The k coefficient ranged from 0.82 to 0.91. Agreement between therapists was almost perfect according to the criteria of Feinstein. The FMS exhibits substantial inter-observer reliability and moderate to substantial validity. We have demonstrated its clinical applications as well as showing it to be a useful management and research tool.
Objective: To measure functional recovery after hip fracture in the subacute setting. Background:... more Objective: To measure functional recovery after hip fracture in the subacute setting. Background: There are over 340,000 hip fractures that occur in the United States annually. Three out of five hospitalizations attributable to injury among persons over 75 were for fractures. Greater than 50% were hip fractures. Purpose: The purpose of this study is to describe the functional recovery after hip fracture in the subacute setting utilizing performance-based measures (PBMs). Method: This is a prospective observational cohort. Data analysis: Descriptive statistics were used for baseline characteristics. Repeated measures analysis using a Bonferroni correction was utilized to compare admission and discharge PBM scores. Results: Eighty residents were enrolled in the study, of which seven were withdrawn because of medical complications and one subject died within 1 week of admission. Data were analyzed for 72 subjects. There were 59 women and 13 men ranging in age from 63-99. Mean age was 85.3. The patients_ profiles were as follows: 53% lived alone, 63% were Medicare recipients, 50% used an assistive device before hip fracture, 46% sustained a femoral neck fracture, 57% underwent a bipolar hemiarthroplasty, 90% received epidural anesthesia, and 90% had a weight-bearing status as weight-bearing was tolerated. The PBM results are as follows: Mean test score of the Tinetti gait and balance, timed up and go (TUG), and 6-min walk (6MW) test, mean (SD). Conclusion: There was a significant improvement between admission and discharge TUG test, Tinetti gait and balance test, and 6MW test scores in patients who underwent surgical repair of a hip fracture after a fall.
The objective of this study was to assess outcomes of traditional treatment of fractures using th... more The objective of this study was to assess outcomes of traditional treatment of fractures using the SF-36 and the Cummings Hip Scale. In designing randomized clinical trials, it is necessary to determine the timing of assessment either for progress or for the main outcome. We set out to document the recovery of patients after surgery for hip fracture using current standard methods of medical care. This was a prospective study of a cohort of patients. Patients who were receiving standard medical care completed the SF-36 and the Cummings Hip Scale at previously determined times postoperatively. The SF-36 has eight subscales, including assessments of physical function, physical role behaviors, bodily pain, mental health, social role, emotional role, vitality and general health. Thirty-eight patients completed the questionnaires at 1 year postoperatively as well as previous time points. On the Cummings Hip Scale and the physical function, bodily pain, mental health, social function, emotional role, vitality and general health subscales of the SF-36, recovery is near complete at 6 months. Only the physical role subscale differs, with a statistically significant difference between the values at 6 months and 1 year, (p = 0.02). Patients attained over 90% of the 1 year value by 6 months for all except the physical role subscale. The physical role subscale reached 85%. For a hip fracture patient who is on the road to recovery, the majority of the recovery has therefore taken place by 6 months.
Proceedings. 17th IEEE Symposium on Computer-Based Medical Systems, 2004
ABSTRACT This paper discusses an attempt to reassign physical therapy evaluations to meaningful t... more ABSTRACT This paper discusses an attempt to reassign physical therapy evaluations to meaningful time periods based on recovery after surgery for hip fracture. The time of each evaluation post surgery is recorded in days and months by the physical therapist doing the evaluation. At the same time, the physical therapist assigns a name to the time period 'pre-strength training', 'post-strength training', '6 month etc'. However the patient and other outside factors affect the actual time that elapses between evaluations. When the study was completed, the early examination of the data, revealed that the period assignments had a wide spread over time. We constructed an expert program, to try to adjust the period name assignments using the actual time post-surgery as well as the time relationship to the strength training.
ABSTRACT More than 300,000 people are hospitalized each year for the treatment of hip fracture. I... more ABSTRACT More than 300,000 people are hospitalized each year for the treatment of hip fracture. It has been reported that mortality rates are as high as 25% for the first year following a hip fracture. The probability of a significant decline in functional independence is high. A Cochrane review concluded that reports of randomized controlled trials did not provide robust evidence of the impact of rehabilitation programs for people who had sustained a hip fracture. This article describes the functional outcome in a randomized controlled trial of implementing a high-intensity exercise training program twice a week for 8 weeks for people who underwent surgical repair of a hip fracture following a mechanical fall.
We conducted a randomized controlled trial to assess the efficacy and safety of a multiple-compon... more We conducted a randomized controlled trial to assess the efficacy and safety of a multiple-component intervention designed to improve functional recovery after hip fracture. One hundred seventy-six patients who underwent surgery for a primary unilateral hip fracture were assigned randomly to receive usual care (control arm, n=86) or a brief motivational videotape, supportive peer counseling, and high-intensity muscle-strength training (intervention arm, n=90). Between-group differences on the physical functioning, role-physical, and social functioning domains of the SF-36 were assessed postoperatively at 6 months. At the end of the trial, 32 intervention and 27 control patients (34%) completed the 6-month outcome assessment. Although patient compliance with all three components of the intervention was uneven, over 90% of intervention patients were exposed to the motivational videotape. Intervention patients experienced a significant (P=0.03) improvement in the role-physical domain (mean change, j11T33) compared to control patients (mean change, j37T41). Change in general health (P=0.2) and mental health (P=0.1) domain scores was also directionally consistent with the study hypothesis. Although our findings are consistent with previous reports of compre
Background: An analysis of practice is conducted by the American Board of Physical Therapy Specia... more Background: An analysis of practice is conducted by the American Board of Physical Therapy Specialties (ABPTS) every 10 years to revalidate, update, and revise the description of specialty practice (DSP) for each specialty. The Geriatric Specialty Council recently conducted an analysis of practice and revised its content consistent with established procedures by the ABPTS. Purpose: The purpose of this article is threefold: first, to describe the process of the most recent practice analysis; second, to report revisions to the description of specialty practice based on the analysis of practice; and third, to identify elements of practice that define current specialist practice in geriatric physical therapy. Methods: A 10-member committee of subject matter experts (SMEs) and a psychometric consultant developed a survey instrument addressing geriatric physical therapy specialty practice areas. The survey was initially pilot-tested and subsequently administered online to a sample of 801 ...
This paper describes physical therapy programs to assist physical therapists in the rehabilitatio... more This paper describes physical therapy programs to assist physical therapists in the rehabilitation of patients with familial dysautonomia. There have been no reports in the literature about a physical therapy program for patients with this disease. A retrospective analysis of the clinical manifestations in 80 patients in a dysautonomia clinic was performed. Scoliosis and kyphosis were found in 92 percent of the patients, 93 percent had ataxia, 74 percent had feeding difficulties, 69 percent had frequent pneumonias, and 63 percent exhibited delayed developmental milestones. Cardiovascular, gastrointestinal, pulmonary, musculoskeletal, and neurological symptoms and treatments are discussed.
Background: To determine if a patented new computer controlled, pressure modulated knee rehabilit... more Background: To determine if a patented new computer controlled, pressure modulated knee rehabilitation machine was more effective, in rehabilitation of total knee arthroplasty, than the continuous passive motion machine utilizing Cochrane Review data. Methods: Prospective study of 197 patients: 59 outpatient rehabilitation facilities; 155 homebased care, and 7 skilled nursing facilities. Patients were prospectively treated with pressure modulated knee rehabilitation and standard rehabilitation for total knee arthroplasty. Range of motion (RoM) was compared (via ANOVA) with the Cochrane continuous passive motion study. We also evaluated RoM outcomes versus start day of pressure modulated knee rehabilitation use. Findings: Pressure modulated knee rehabilitation patient's ROM, at 30 days, exceeded 116°; significantly greater than all shortterm (6 weeks) Cochrane Review studies (83°). Patients using the pressure modulated knee rehabilitation six or more days after surgery had a significantly lower 14-day RoM than patients who began on days 1-5 following surgery. Interpretation: The pressure modulated knee rehabilitation patients increase their RoM following total knee arthroplasty significantly more than continuous passive motion users.
To compare the effects of epidural anesthesia and general anesthesia on early postoperative outco... more To compare the effects of epidural anesthesia and general anesthesia on early postoperative outcomes after unilateral primary total knee replacement, 262 patients were randomly assigned to receive either epidural or general anesthesia. All patients received a common rehabilitation protocol including a standardized assessment of progress. One hundred eightyeight patients received a common thromboembolic prophylaxis protocol with postoperative aspirin, and had a standardized surveillance protocol to detect thromboembolic complications. Deep vein thrombosis was determined by venography on the operative limb, and pulmonary embolism was determined by comparison of preoperative and postoperative lung perfusion scans. The epidural anesthesia
To describe a functional milestone scale (FMS) for measuring functional progression following tot... more To describe a functional milestone scale (FMS) for measuring functional progression following total hip arthroplasty and to demonstrate that this scale meets accepted standards of scale construction. Inter-observer reliability of the scale was determined for 30 patients using a kappa coefficient of concordance (k) for ordinal data, representing 221 pairs of observations. There were 79, 54, 44, and 44 pairs of observations for transfer, walker, crutch, and stair ambulation, respectively. The k coefficient ranged from 0.82 to 0.91. Agreement between therapists was almost perfect according to the criteria of Feinstein. The FMS exhibits substantial inter-observer reliability and moderate to substantial validity. We have demonstrated its clinical applications as well as showing it to be a useful management and research tool.
Objective: To measure functional recovery after hip fracture in the subacute setting. Background:... more Objective: To measure functional recovery after hip fracture in the subacute setting. Background: There are over 340,000 hip fractures that occur in the United States annually. Three out of five hospitalizations attributable to injury among persons over 75 were for fractures. Greater than 50% were hip fractures. Purpose: The purpose of this study is to describe the functional recovery after hip fracture in the subacute setting utilizing performance-based measures (PBMs). Method: This is a prospective observational cohort. Data analysis: Descriptive statistics were used for baseline characteristics. Repeated measures analysis using a Bonferroni correction was utilized to compare admission and discharge PBM scores. Results: Eighty residents were enrolled in the study, of which seven were withdrawn because of medical complications and one subject died within 1 week of admission. Data were analyzed for 72 subjects. There were 59 women and 13 men ranging in age from 63-99. Mean age was 85.3. The patients_ profiles were as follows: 53% lived alone, 63% were Medicare recipients, 50% used an assistive device before hip fracture, 46% sustained a femoral neck fracture, 57% underwent a bipolar hemiarthroplasty, 90% received epidural anesthesia, and 90% had a weight-bearing status as weight-bearing was tolerated. The PBM results are as follows: Mean test score of the Tinetti gait and balance, timed up and go (TUG), and 6-min walk (6MW) test, mean (SD). Conclusion: There was a significant improvement between admission and discharge TUG test, Tinetti gait and balance test, and 6MW test scores in patients who underwent surgical repair of a hip fracture after a fall.
The objective of this study was to assess outcomes of traditional treatment of fractures using th... more The objective of this study was to assess outcomes of traditional treatment of fractures using the SF-36 and the Cummings Hip Scale. In designing randomized clinical trials, it is necessary to determine the timing of assessment either for progress or for the main outcome. We set out to document the recovery of patients after surgery for hip fracture using current standard methods of medical care. This was a prospective study of a cohort of patients. Patients who were receiving standard medical care completed the SF-36 and the Cummings Hip Scale at previously determined times postoperatively. The SF-36 has eight subscales, including assessments of physical function, physical role behaviors, bodily pain, mental health, social role, emotional role, vitality and general health. Thirty-eight patients completed the questionnaires at 1 year postoperatively as well as previous time points. On the Cummings Hip Scale and the physical function, bodily pain, mental health, social function, emotional role, vitality and general health subscales of the SF-36, recovery is near complete at 6 months. Only the physical role subscale differs, with a statistically significant difference between the values at 6 months and 1 year, (p = 0.02). Patients attained over 90% of the 1 year value by 6 months for all except the physical role subscale. The physical role subscale reached 85%. For a hip fracture patient who is on the road to recovery, the majority of the recovery has therefore taken place by 6 months.
Proceedings. 17th IEEE Symposium on Computer-Based Medical Systems, 2004
ABSTRACT This paper discusses an attempt to reassign physical therapy evaluations to meaningful t... more ABSTRACT This paper discusses an attempt to reassign physical therapy evaluations to meaningful time periods based on recovery after surgery for hip fracture. The time of each evaluation post surgery is recorded in days and months by the physical therapist doing the evaluation. At the same time, the physical therapist assigns a name to the time period 'pre-strength training', 'post-strength training', '6 month etc'. However the patient and other outside factors affect the actual time that elapses between evaluations. When the study was completed, the early examination of the data, revealed that the period assignments had a wide spread over time. We constructed an expert program, to try to adjust the period name assignments using the actual time post-surgery as well as the time relationship to the strength training.
ABSTRACT More than 300,000 people are hospitalized each year for the treatment of hip fracture. I... more ABSTRACT More than 300,000 people are hospitalized each year for the treatment of hip fracture. It has been reported that mortality rates are as high as 25% for the first year following a hip fracture. The probability of a significant decline in functional independence is high. A Cochrane review concluded that reports of randomized controlled trials did not provide robust evidence of the impact of rehabilitation programs for people who had sustained a hip fracture. This article describes the functional outcome in a randomized controlled trial of implementing a high-intensity exercise training program twice a week for 8 weeks for people who underwent surgical repair of a hip fracture following a mechanical fall.
We conducted a randomized controlled trial to assess the efficacy and safety of a multiple-compon... more We conducted a randomized controlled trial to assess the efficacy and safety of a multiple-component intervention designed to improve functional recovery after hip fracture. One hundred seventy-six patients who underwent surgery for a primary unilateral hip fracture were assigned randomly to receive usual care (control arm, n=86) or a brief motivational videotape, supportive peer counseling, and high-intensity muscle-strength training (intervention arm, n=90). Between-group differences on the physical functioning, role-physical, and social functioning domains of the SF-36 were assessed postoperatively at 6 months. At the end of the trial, 32 intervention and 27 control patients (34%) completed the 6-month outcome assessment. Although patient compliance with all three components of the intervention was uneven, over 90% of intervention patients were exposed to the motivational videotape. Intervention patients experienced a significant (P=0.03) improvement in the role-physical domain (mean change, j11T33) compared to control patients (mean change, j37T41). Change in general health (P=0.2) and mental health (P=0.1) domain scores was also directionally consistent with the study hypothesis. Although our findings are consistent with previous reports of compre
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