The Case for Developing a Movement System Framework for Older Adults.

Leaders and scholars from multiple academies of the American Physical Therapy Association are developing and defining movement system diagnoses to guide practice. However, there is no consensus on the need for or content of such frameworks. This Perspective describes current thought about movement system diagnoses in physical therapy and summarizes the work of the Academy of Geriatrics (APTA Geriatrics) Movement System Diagnosis Task Force (GMS-TF) as it contributes to the movement system diagnosis discussion within the profession. Initially convened to define movement system diagnostic labels unique to older adults, the GMS-TF's developmental process identified the need for a clearer diagnostic framework onto which specific diagnoses will later be added. Although The World Health Organization International Classification of Functioning, Disability and Health model is a strong foundation for the patient-client management model, the GMS-TF proposes formal incorporation of the Geriatric 5Ms (mobility, medications, memory, multi-complexity, and "what matters most") into a movement system framework for older adults. The GMS-TF concurs with the APTA Academy of Neurology Movement System Task Force proposal that observation and analysis of key functional tasks are the foundation of any examination of older adults. The GMS-TF suggests adding several additional movement tasks that are important for older adults. The GMS-TF believes that this strategy highlights the health care needs of older adults and prioritizes physical therapist care for older adults with complex needs. This Perspective is the foundation for a future movement system diagnosis model for older adults that will complement and facilitate the development of models of care to be applied across the lifespan.

Academy of Geriatric Physical Therapy Research Agenda: Rationale for the Development and the Intent for Use.

The rationale for the development and the intent for use of a research agenda for the Academy of Geriatric Physical Therapy is described. The reasons for the research agenda for geriatric physical therapy are (1) to have a broad representation of the research conducted by physical therapist(s) working with older adults, (2) to provide guidance and assistance to emerging investigators to aid the trajectory of a research career, and (3) as a document to engage potential funding agencies, foundations, and individuals in support of physical therapist-conducted research. The design was based on the Research Agenda for Physical Therapy (APTA document), formatted to be consistent with the World Health Organization International Classification of Functioning, Disability and Health, priority ratings for the research statements, and specific examples of research questions for each category of the Research Agenda. The Academy of Geriatric Physical Therapy Research Agenda generated to be a living document, with revisions to research questions and priority ratings expected in the future to enable the agenda to adapt to changes in science, practice, workforce, education, and health policy.

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.

The effects of a home-based exercise program on balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults: a pilot study.

PURPOSE: The purpose of this pilot study was to evaluate the effects of a home-based standing exercise and balance training program on balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults. METHODS: A quasi-experimental single group pre- to posttest design was utilized in 14 subjects, 9 male and 5 female, aged 71 to 85 years receiving home care. Measurements included the Falls Efficacy Scale (FES), Performance Oriented Mobility Assessment (POMA), and the One-Leg Stance Test (OLST) administered prior to and following 4 weeks of exercise and balance training. Participants trained twice per day, 5 days per week for 4 weeks, and maintained exercise logs. RESULTS: Pre- to posttest differences on the FES, POMA, and OLST were analyzed with the Wilcoxon signed rank test and the 2-tailed paired t test, respectively, with statistical significance set at .05. Analysis demonstrated significant improvements on the FES, POMA, and OLST following 4-weeks of standing exercise and balance training. Based on entrance and exit interviews, 6 of the 14 participants had a history of falls in the 6 months prior to the study, while only 2 participants reported having a single, minor fall by discharge. CONCLUSIONS: The results of the present pilot study demonstrated significant improvement in balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults following participation in a home-based exercise and balance training program. However, definitive conclusions need to await validation from more rigorously designed studies before the present training program can be confidently recommended to physical therapists engaged in home care practice.

The Value of Home Health Physical Therapy.

The purpose of the Triple Aim is to improve population health, reduce healthcare costs, and improve the patient experience. These goals-to reduce cost while improving health outcomes and patient experiences have shifted utilization of services from other postacute care settings to the home. The purpose of this perspective article is to discuss how home healthcare services, and home physical therapy (PT) specifically, provide value to patients, caregivers, and payers to meet the goals of the Triple Aim. This article will substantiate the value of home PT and provide healthcare professionals with evidence-based information on the value of home PT.

Nuclear/radiological terrorism: emergency department management of radiation casualties.

Recent world events have increased concern that hospitals must be prepared for radiological emergencies. Emergency departments (EDs) must be ready to treat patients suffering from injuries in combination with radiation exposure or contamination with radioactive material. Every hospital should have a Radiological Emergency Medical Response Plan, tested through periodic drills, which will allow effective handling of contaminated and injured patients. Treatment of life-threatening or severe traumatic injuries must take priority over radiation-related issues. The risk to ED staff from radioactive contamination is minimal if universal precautions are used. The likelihood of significant radiation exposure to staff under most circumstances is small. Educating medical staff on the magnitude of the radiological hazards allows them to promptly and confidently provide the necessary patient care. Measures must be taken to prevent the "worried well" and uninjured people with radioactive contamination from overwhelming the ED.

Patient centered care: A path to better health outcomes through engagement and activation.

BACKGROUND: Patient Activation and Health confidence are constructs to assess patient engagement and are utilized to encourage patient engagement. A health care provider may increase patient engagement further by utilizing behavior change theories and models such as the Trans-Theoretical Model of Change (TTM), Self-Determination Theory (SDT) and Motivational Interviewing (MI) to realize effective and lasting health behavior change by placing accountability increasingly on the patient/caregiver to choose to make changes in their health behavior on their terms. Reducing or eliminating harmful behaviors such as smoking and/or beginning or increasing beneficial health behaviors such as diet modification or performance of an exercise program, patients realize improved outcomes and better health. PURPOSE: The purpose of this article is to define health confidence as a measurement tool for patient engagement, use the TTM as a measure of the patient's readiness to change, use TTM, SDT and MI as interventional approaches to effect patient change of behavior encouraged by physical therapists and incorporate the ICF as a means of identifying barriers and facilitators and incorporate the bio-psychosocial model for patient-centered care to improve health behavior, health and patient outcomes. CONCLUSION: Patient-centered care requires involvement of the patient and/or their caregiver at the center of the plan. Use of the International Classification of Functioning, Disability and Health (ICF) to identify facilitators and barriers unique to the patient/caregiver offers another opportunity to successfully engage the patient by incorporating the patient's bio-psychosocial support system into care delivery and for sustainability. The ICF is a taxonomy and classification system that prompts clinicians to identify environmental factors (facilitators and barriers) that will influence the patient's ability to perform during therapy session and to sustain the interventions and employ suggestions outside of formal therapy sessions. Using the facilitators to encourage sustainable change and removing barriers, patients are more likely to realize positive health behavior change and in turn demonstrate improved outcomes and health as a result of physical therapy intervention.

Operational health physics.

A review of the operational health physics papers published in Health Physics and Operational Radiation Safety over the past fifteen years indicated seventeen general categories or areas into which the topics could be readily separated. These areas include academic research programs, use of computers in operational health physics, decontamination and decommissioning, dosimetry, emergency response, environmental health physics, industrial operations, medical health physics, new procedure development, non-ionizing radiation, radiation measurements, radioactive waste disposal, radon measurement and control, risk communication, shielding evaluation and specification, staffing levels for health physics programs, and unwanted or orphan sources. That is not to say that there are no operational papers dealing with specific areas of health physics, such as power reactor health physics, accelerator health physics, or governmental health physics. On the contrary, there have been a number of excellent operational papers from individuals in these specialty areas and they are included in the broader topics listed above. A listing and review of all the operational papers that have been published is beyond the scope of this discussion. However, a sampling of the excellent operational papers that have appeared in Health Physics and Operational Radiation Safety is presented to give the reader the flavor of the wide variety of concerns to the operational health physicist and the current areas of interest where procedures are being refined and solutions to problems are being developed.

Operational health physics.

A review of the operational health physics papers published in Health Physics and Operational Radiation Safety over the past fifteen years indicated seventeen general categories or areas into which the topics could be readily separated. These areas include academic research programs, use of computers in operational health physics, decontamination and decommissioning, dosimetry, emergency response, environmental health physics, industrial operations, medical health physics, new procedure development, non-ionizing radiation, radiation measurements, radioactive waste disposal, radon measurement and control, risk communication, shielding evaluation and specification, staffing levels for health physics programs, and unwanted or orphan sources. That is not to say that there are no operational papers dealing with specific areas of health physics, such as power reactor health physics, accelerator health physics, or governmental health physics. On the contrary, there have been a number of excellent operational papers from individuals in these specialty areas and they are included in the broader topics listed above. A listing and review of all the operational papers that have been published is beyond the scope of this discussion. However, a sampling of the excellent operational papers that have appeared in Health Physics and Operational Radiation Safety is presented to give the reader the flavor of the wide variety of concerns to the operational health physicist and the current areas of interest where procedures are being refined and solutions to problems are being developed.